Carolyn Anne Sullivan, AC PNP

Primary specialty

Critical Care Pediatric Nurse PractitionerTaxonomy code 363LP0222X

License

2015003901 Issued in MO

Practice address

3231 S National Ave
Suite 115
Springfield, MO 65807-7304

Phone

(417) 885-0824

Fax

(417) 890-4174

NPI assigned

Dec 5, 2011

Last updated

Nov 19, 2015By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: csullivan710318@directc.mercy.net

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.

• Mercy Clinic Springfield Communities

  • Family Medicine Physician
  • Springfield, MO
  • NPI 1245277631
  Medicare reassignment NPD
• Mercy Clinic Springfield Communities

  dba Mercy Clinic Family Medicine-Willow Springs

  • Rural Health Clinic/Center
  • Willow Springs, MO
  • NPI 1972771657
  NPD
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447891200000",
    "number": "1225306269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505164",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631505164",
            "telephone_number": "417-829-4620",
            "fax_number": "417-829-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3231 S NATIONAL AVE",
            "address_2": "SUITE 115",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658077304",
            "telephone_number": "417-885-0824",
            "fax_number": "417-890-4174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "CAROLYN",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "AC PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-05",
        "last_updated": "2015-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "IL",
            "license": "209009257",
            "primary": false
        },
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "MO",
            "license": "2015003901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225306269",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Suh, DC
• Ra Young Suh, LCSW
• Naseem Majid Sulayman, MD
• Hannah B Sullens, LPC
• Amy Elizabeth Sullins
• Dan T Sullivan, M.D.
• Josie R Sullivan, APRN
• Michael Leon Sullivan, PTA
• Scott R Sullivan, DDS, MD
• Netti Jo Summer, PH.D.

• Critical Care Pediatric Nurse Practitioner in Springfield, MO
• Providers in Springfield, MO by specialty
• Critical Care Pediatric Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.