NPIMap

Individual provider Active NPI

Jill Maxwell Sullivan, M.D.

  • Internal Medicine Physician
  • Greenville, SC
National Provider Identifier
1174818355
Registry record updated Jun 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
33553 Issued in SC
Practice address
701 Grove Rd
GHS Med-Peds Residency
Greenville, SC 29605-5611
Phone
(864) 455-7844
Fax
(864) 455-7848
NPI assigned
Jun 15, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 33553 SC Primary
Pediatrics Physician 208000000X 33553 SC

Addresses

Primary practice location

701 Grove Rd
GHS Med-Peds Residency
Greenville, SC 29605-5611

Mailing address

701 Grove Rd
GHS Med-Peds Residency
Greenville, SC 29605-5611
Phone (864) 455-7844

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181206003388 SC Practitioner - Hematology/Oncology 2365607629 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
University of South Carolina School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Carolina Oncology Assoc PAGroup PAC ID 6103739024, 18 clinicians

Practice addresses (Care Compare)

166 Stoneridge Dr
Columbia, SC 29210-8239
Phone (803) 461-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
33553SCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Carolina Oncology Assoc PA CurrentSince Aug 13, 2018 Accepting new patients

Locations

166 Stoneridge Dr
Columbia, SC 29210
Phone (803) 296-5954

Organizations & group practices 1

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308096000000",
    "number": "1174818355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 GROVE RD",
            "address_2": "GHS MED-PEDS RESIDENCY",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296055611",
            "telephone_number": "864-455-7844",
            "fax_number": "864-455-7848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE RD",
            "address_2": "GHS MED-PEDS RESIDENCY",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296055611",
            "telephone_number": "864-455-7844",
            "fax_number": "864-455-7848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JILL",
        "middle_name": "MAXWELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-15",
        "last_updated": "2011-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "33553",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "33553",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.