ANNE LORRAINE SELF SULLIVAN (MD) – Family Medicine Physician, NPI 1114913555
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
941 FAMILY PRACTICE in MS
Provider Addresses for ANNE LORRAINE SELF SULLIVAN (MD)
PO BOX 405827
ATLANTA, GA 303845800
Phone:
Type: Mailing
7736 Airways Blvd
Southaven, MS 386715306
Phone: (662) 772-5222
Fax: (662) 772-5957
Type: Location
1520, Union Avenue, Annesdale Park, Midtown, Memphis, Shelby County, West Tennessee, Tennessee, 38104, United States
MEMPHIS, TN 381740275
Phone: (901) 276-2410
Type: Location
965 RIDGE LAKE BLVD STE 315
MEMPHIS, TN 381209401
Phone:
Fax: (901) 227-8591
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $72.
Total Amount is formed as General ($72) + Research ($0) + Ownership ($0) = $72.
Last reported payment date: 2024-11-19 • Largest payer in this snapshot: Boston Scientific Corporation ($31).
Total Amount
$72
General + Research + Ownership
Payments
4
Total payment records
General Amount
$72
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-19
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Boston Scientific Corporation | $31 |
| ABIOMED | $21 |
| Boehringer Ingelheim Pharmaceuticals, Inc. | $21 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-12-15
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20120608000186 | I | Family Practice | TN | TBD |
| I20211215003052 | I | Family Practice | MS | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30384)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| Osteopathic Manipulative Medicine | NY | |
| N E U R O L O G Y | CT | |
| Nurse Practitioner | GA | |
| Nurse Practitioner | MS | |
| Internal Medicine | AR | |
| Internal Medicine | GA | |
| Nurse Practitioner | TN | |
| Internal Medicine | TN | |
| P S Y C H I A T R Y | OH | |
| Nurse Practitioner | MS |
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