Katie Leigh Sullivan, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10366-24 Issued in WI

Practice address

1630 Commanche Ave
Green Bay, WI 54313-6089

Phone

(920) 433-4700

NPI assigned

Jul 21, 2006

Last updated

Feb 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/0cda6ed7-9e18-4112-ab11-d5a45a40c8d5/
• Direct secure messaging: ksullivan32309@direct.thedacare.org

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.

• Bellin Memorial Hospital Inc

  dba Bellin Health Algoma

  • Rural Health Clinic/Center
  • Algoma, WI
  • NPI 1609838473
  Medicare reassignment Care Compare group NPD
• Bellin Memorial Hospital Inc

  dba Bellin Health

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1033172390

  Physical Therapist

  NPD
• Bellin Memorial Hospital Inc

  dba FMC Oconto Falls

  • Rural Health Clinic/Center
  • Oconto Falls, WI
  • NPI 1285696963
  NPD
• Orthopedic & Sports Medicine Specialists of Green Bay, SC

  • Specialist
  • Green Bay, WI
  • NPI 1760670145
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1073534863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 COMMANCHE AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543136089",
            "telephone_number": "920-433-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "595 County Road R",
            "address_purpose": "LOCATION",
            "city": "Denmark",
            "state": "WI",
            "postal_code": "542089120",
            "country_code": "US",
            "telephone_number": "920-863-2005",
            "fax_number": "920-863-6416",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "964 W Ryan St",
            "address_purpose": "LOCATION",
            "city": "Brillion",
            "state": "WI",
            "postal_code": "541101076",
            "country_code": "US",
            "telephone_number": "920-756-2055",
            "fax_number": "920-756-3350",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "140B School Creek Trl",
            "address_purpose": "LOCATION",
            "city": "Luxemburg",
            "state": "WI",
            "postal_code": "542171095",
            "country_code": "US",
            "telephone_number": "920-845-1370",
            "fax_number": "920-845-1379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KATIE",
        "middle_name": "LEIGH",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10366-24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT",
            "identifier": "10366-24",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Rani Sud, MD
• Sue Huber & Associates, S.C.
• William Halyburton Suits, DPT
• Samuel Sule-Saa, MD
• Jaclyn Sullivan, LAT
• Thomas Andrew Sullivan, MD
• Tammy L Summers, RD (DIETITIAN)
• Paul R Summerside, MD
• Sunridge Dental LLC
• Cynthia L Suplinski, APNP

• Physical Therapist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.