Sandra Jean Sullivan, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

3056 Issued in NH

Practice address

1976 White Mountain Hwy Ste 105
North Conway, NH 03860-5147

Phone

(603) 356-4940

NPI assigned

Jan 15, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mainehealth New Hampshire Ambulatory CareGroup PAC ID 9436659968, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital, the Hospital, North Conway, NH, CCN 301307

Merit-based Incentive Payment System (MIPS)

Final score

91.98 of 100Reported as apm

Quality

76.59

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ssullivan9356@direct.bilh.masshiway.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mainehealth New Hampshire Ambulatory Care

  • Urgent Care Clinic/Center
  • North Conway, NH
  • NPI 1356145148
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Memorial Hospital

  • Critical Access Hospital
  • North Conway, NH
  • NPI 1700864709
  Care Compare affiliation
• Memorial Hospital

  • Family Medicine Physician
  • North Conway, NH
  • NPI 1992000103

  Hospital

  Care Compare affiliation
• The Memorial Hospital

  • Obstetrics & Gynecology Physician
  • North Conway, NH
  • NPI 1366421141

  Hospital

  Care Compare affiliation
• The Memorial Hospital

  • Orthopaedic Surgery Physician
  • North Conway, NH
  • NPI 1619968849

  Hospital

  Care Compare affiliation
• The Memorial Hospital

  • Endocrinology, Diabetes & Metabolism Physician
  • North Conway, NH
  • NPI 1629060926

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767830400000",
    "number": "1003967407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1976 WHITE MOUNTAIN HWY STE 105",
            "city": "NORTH CONWAY",
            "state": "NH",
            "postal_code": "038605147",
            "telephone_number": "603-356-4940",
            "fax_number": "603-371-3250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1976 WHITE MOUNTAIN HWY STE 105",
            "city": "NORTH CONWAY",
            "state": "NH",
            "postal_code": "038605147",
            "telephone_number": "603-356-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SANDRA",
        "middle_name": "JEAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NH",
            "license": "3056",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "3056",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Sponseller, MD
• Alison St Jeanos
• Sara Ryan Sterl, PA
• Structured Chiropractic, Inc
• Brendan G. Sullivan
• Sunbridge Clipper Home of North Conway LLC
• Rachel Tatulis
• Douglas C. Taylor, M.D.
• Mary J. Thayer, M.S., A.R.N.P.
• The Memorial Hospital

• Medical Physician Assistant in North Conway, NH
• Providers in North Conway, NH by specialty
• Medical Physician Assistant in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.