Alyssa Ann Sundstrom, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

RN269516 Issued in MA

Practice address

630 Plantation St
Wot 12TH FL
Worcester, MA 01605-2038

Phone

(508) 852-8570

Fax

(508) 852-1022

NPI assigned

Jul 18, 2015

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 names 1

• Alyssa A. Guertin Former name

Medicare fee-for-service enrollment

Enrolled in MA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: alyssa.sundstrom.npi1083098107.reliant@direct.optumcare.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.

• Reliant Medical Group, Inc

  • Family Medicine Physician
  • Worcester, MA
  • NPI 1720017528
  Medicare reassignment
• Reliant Medical Group, Inc

  • Physical Therapist
  • Worcester, MA
  • NPI 1295827962
  NPD (past)

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

{
    "created_epoch": "1437177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437177600000",
    "number": "1083098107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 PLANTATION ST",
            "address_2": "WOT 12TH FL",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052038",
            "telephone_number": "508-368-5532",
            "fax_number": "508-852-1022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 PLANTATION ST",
            "address_2": "WOT 12TH FL",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052038",
            "telephone_number": "508-852-8570",
            "fax_number": "508-852-1022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDSTROM",
        "first_name": "ALYSSA",
        "middle_name": "ANN",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-18",
        "last_updated": "2015-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "RN269516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "GUERTIN",
            "middle_name": "A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Concetta Marie Sumner
• Sun Dental Center
• Sunbridge Healthcare Corporation
• Sunbridge Healthcare LLC
• Skylar Paige Sundquist, MD
• Arno S. Sungarian, M.D.
• Sanjita B Sunnam, MD
• Sunnyside Behavioral Health Corp
• Sunrise Homecare Services LLC
• Sunrise Prosthetics & Orthotics, Inc.

• Pediatric Nurse Practitioner in Worcester, MA
• Providers in Worcester, MA by specialty
• Pediatric Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.