Active NPI
Jennifer Marie Sult, MD
- Family Medicine Physician
- Rochester, IN
National Provider Identifier
1043436009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01062520A
- Practice address
- 1400 E 9TH St
Rochester, IN 46975-8931 - Phone
- (574) 223-2020
- Fax
- (574) 223-5847
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 01062520A | IN | |
| Family Medicine Physician | 207Q00000X | 01062520A | IN | Primary |
Addresses
Primary practice location
1400 E 9TH St
Rochester, IN 46975-8931
Mailing address
1400 E 9TH St
Rochester, IN 46975-8931
Phone (574) 223-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200863600 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2022 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital of South Bend | Past | Accepting new patients | |
| Woodlawn Hospital | Family Medicine | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Acute Care Hospital
- South Bend, IN
- NPI 1295772093
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412208000000",
"number": "1043436009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 E 9TH ST",
"city": "ROCHESTER",
"state": "IN",
"postal_code": "469758931",
"telephone_number": "574-223-2020",
"fax_number": "574-223-5847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 E 9TH ST",
"city": "ROCHESTER",
"state": "IN",
"postal_code": "469758931",
"telephone_number": "574-223-2020",
"fax_number": "574-223-5847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULT",
"first_name": "JENNIFER",
"middle_name": "MARIE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2014-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "IN",
"license": "01062520A",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01062520A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200863600",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rochester, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.