Active NPI
Gerromi Sullivan, BS, LAT, ATC
- Athletic Trainer
- Essex, MD
National Provider Identifier
1073269320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- A0001160
- Practice address
- 1801 Turkey Point Rd
Essex, MD 21221-1734 - Phone
- (240) 602-6626
- NPI assigned
- Feb 24, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | A0001160 | MD | Primary |
Addresses
Primary practice location
1801 Turkey Point Rd
Essex, MD 21221-1734
Mailing address
6110 Breezewood Dr Apt 104
Greenbelt, MD 20770-4148
Phone (240) 602-6626
Other practice location 1
6110 Breezewood Dr Apt 104
Greenbelt, MD 20770-4148
Phone (240) 602-6626
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A0001160 | MD | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645660800000",
"number": "1073269320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6110 BREEZEWOOD DR APT 104",
"city": "GREENBELT",
"state": "MD",
"postal_code": "207704148",
"telephone_number": "240-602-6626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 TURKEY POINT RD",
"city": "ESSEX",
"state": "MD",
"postal_code": "212211734",
"telephone_number": "240-602-6626"
}
],
"practiceLocations": [
{
"address_1": "6110 Breezewood Dr Apt 104",
"address_purpose": "LOCATION",
"city": "Greenbelt",
"state": "MD",
"postal_code": "207704148",
"country_code": "US",
"telephone_number": "240-602-6626",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SULLIVAN",
"first_name": "GERROMI",
"name_prefix": "Mr.",
"credential": "BS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-02-24",
"last_updated": "2022-02-24",
"certification_date": "2022-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MD",
"license": "A0001160",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Essex, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.