Laura Nastassja Sullivan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-04483 Issued in NC

Practice address

1011 Pemberton Hill Rd
Ste 101
Apex, NC 27502-4266

Phone

(919) 620-4700

NPI assigned

Sep 27, 2013

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

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Carolina MG LLCGroup PAC ID 1951828847, 723 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rex Hospital Hospital, Raleigh, NC, CCN 340114

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lsullivan851522@direct.unc.nchie.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.

• North Carolina MG, LLC

  • Hospitalist Physician
  • Raleigh, NC
  • NPI 1215741640
  Medicare reassignment Care Compare group
• Duke Health Integrated Practice, Inc.

  • General Practice Physician
  • Durham, NC
  • NPI 1205553369
  Medicare reassignment NPD
• Duke University Affiliated Physicians, Inc.

  • Internal Medicine Physician
  • Durham, NC
  • NPI 1316975972
  Medicare reassignment
• Duke Health Integrated Practice, Inc

  • Gastroenterology Physician
  • Raleigh, NC
  • NPI 1780374884
  NPD
• Duke University Affiliated Physicians

  • Family Medicine Physician
  • Cary, NC
  • NPI 1053791343
  NPD
• Duke University Affiliated Physicians, Inc.

  • Emergency Medicine Physician
  • Raleigh, NC
  • NPI 1710120795
  NPD
• Rex Hospital Inc

  • Cardiovascular Disease Physician
  • Raleigh, NC
  • NPI 1972939643
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Rex Hospital Inc.

  • General Acute Care Hospital
  • Raleigh, NC
  • NPI 1497797088
  Care Compare affiliation

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

{
    "created_epoch": "1380240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1124455704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751274",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751274",
            "telephone_number": "919-620-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 PEMBERTON HILL RD",
            "address_2": "STE 101",
            "city": "APEX",
            "state": "NC",
            "postal_code": "275024266",
            "telephone_number": "919-620-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11200 Governor Manly Way Ste 114",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276147360",
            "country_code": "US",
            "telephone_number": "919-570-7660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "LAURA",
        "middle_name": "NASTASSJA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-27",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lsullivan851522@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "11200 Governor Manly Way Ste 114",
            "city": "Raleigh",
            "state": "NC",
            "country_code": "US",
            "postal_code": "276147360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Megan G Strasser, MS OTR/L
• Michelle Lee Stroup, FNP
• James Raymond Strunk, D.C.
• Karen W Suarez, MS CCC-SLP
• Adria Sullivan, LMHC
• Ayesha Sultana, MD
• NFN Sumedha, MD
• Peter James Summers, PH.D.
• Kimberly Anne Summerville, OTR/L
• Jared Kyle Surbaugh, D.C.

• Physician Assistant in Apex, NC
• Providers in Apex, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; 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.
• 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.