Active NPI
Letitia L Sullivan, CNM
- Advanced Practice Midwife
- Brockton, MA
National Provider Identifier
1144296500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- 116166
- Practice address
- 110 Liberty St
Brockton, MA 02301-5521 - Phone
- (508) 894-0400
- Fax
- (508) 565-0157
- NPI assigned
- Feb 27, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | 116166 | MA | Primary |
Addresses
Primary practice location
110 Liberty St
Brockton, MA 02301-5521
Mailing address
110 Liberty St
Brockton, MA 02301-5521
Phone (508) 894-0400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0387011 | Medicaid | MA |
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)
- Enrolled
- Credentials
- Certified Nurse Midwife
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Signature Healthcare Medical Group Inc | Past | Accepting new patients | |
| Women's Health Affiliates, Inc. | Past | Accepting new patients | |
| Atrius Health, Inc. | Past | Accepting new patients | |
| Bridgewater Goddard Park Medical Associates, Inc. | Past | Accepting new patients |
Organizations & group practices 4
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.
-
dba Harvard Vanguard Medical Associates
- Internal Medicine Physician
- Boston, MA
- NPI 1740238526
-
dba Signature Medical Group
- Multi-Specialty Clinic/Center
- Brockton, MA
- NPI 1417932591
-
dba Signature Medical
- Internal Medicine Physician
- Brockton, MA
- NPI 1508804949
-
dba Signature Healthcare Women's Health Affiliates
- Obstetrics & Gynecology Physician
- Brockton, MA
- NPI 1396783742
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144296500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 LIBERTY ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023015521",
"telephone_number": "508-894-0400",
"fax_number": "508-565-0157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 LIBERTY ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023015521",
"telephone_number": "508-894-0400",
"fax_number": "508-565-0157"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "LETITIA",
"middle_name": "L",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "MA",
"license": "116166",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0387011",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.