Individual provider Active NPI

Tiyika Janaye Sullivan, NURSE PRACTITIONER

  • Adult Health Nurse Practitioner
  • Winston Salem, NC
National Provider Identifier
1063803740
Registry record updated Oct 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
5007480 Issued in NC
Practice address
4692 Brownsboro Rd
Winston Salem, NC 27106-3410
Phone
(336) 251-1114
Fax
(336) 251-1115
NPI assigned
Feb 17, 2015
Last updated
Oct 13, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 5007480 NC Primary

Addresses

Primary practice location

4692 Brownsboro Rd
Winston Salem, NC 27106-3410

Mailing address

4692 Brownsboro Rd
Winston Salem, NC 27106-0000
Phone (336) 251-1114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20150331000623 NC Practitioner - Nurse Practitioner 9335466440 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Cincinnati College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Curana Health of North Carolina PLLCGroup PAC ID 1850774332, 274 clinicians

Practice addresses (Care Compare)

4692 Brownsboro Rd
Winston Salem, NC 27106-3410
Phone (337) 991-9276

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Eldercare PA CurrentSince Mar 16, 2015 Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince Mar 31, 2022 Accepting new patients
Curana Health of North Carolina PLLC CurrentSince Sep 7, 2022 Accepting new patients

Locations

5306 NC Highway 55
Ste 105
Durham, NC 27713
Phone (919) 457-1517

555 Fayetteville St
Raleigh, NC 27601
Phone (682) 268-1011

4692 Brownsboro Rd
Winston Salem, NC 27106
Phone (336) 251-1114

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1424131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1063803740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4692 BROWNSBORO RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271060000",
            "telephone_number": "336-251-1114",
            "fax_number": "336-251-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4692 BROWNSBORO RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063410",
            "telephone_number": "336-251-1114",
            "fax_number": "336-251-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "TIYIKA",
        "middle_name": "JANAYE",
        "name_prefix": "Dr.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-17",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "5007480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.