Individual provider Active NPI

Rose Elizabeth Sullivan, CRNA

  • Certified Registered Nurse Anesthetist
  • O Fallon, MO
National Provider Identifier
1225425358
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2015011476 Issued in MO
Practice address
2 Progress Point Pkwy
Dept Anesthesiology
O Fallon, MO 63368-2205
Phone
(800) 862-9980
Fax
(314) 362-1185
NPI assigned
Apr 15, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 2015011476 MO Primary

Addresses

Primary practice location

2 Progress Point Pkwy
Dept Anesthesiology
O Fallon, MO 63368-2205

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (800) 862-9980

Other identifiers 1

IdentifierTypeStateIssuer
910022184MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150619001411 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 6406167279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

2 Progress Point Pkwy
O Fallon, MO 63368-2205
Phone (636) 344-1000

Hospital & facility affiliations

  • Progress West Hospital Hospital, Ofallon, MO, CCN 260219

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
2015011476MOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Oct 1, 2020 Accepting new patients
Washington University CurrentSince Oct 1, 2020 Accepting new patients

Locations

2 Progress Point Pkwy
O Fallon, MO 63368
Phone (636) 344-1000

3015 N Ballas Rd
Saint Louis, MO 63131
Phone (314) 996-5330

660 S Euclid Ave
#8054
Saint Louis, MO 63110
Phone (314) 286-1045

4960 Childrens Pl
Fl 2
Saint Louis, MO 63110
Phone (314) 362-1520

1 Barnes Jewish Hospital Plz
#P
Saint Louis, MO 63110
Phone (618) 474-1074

Organizations & group practices 2

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1225425358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "800-862-9980",
            "fax_number": "314-362-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 PROGRESS POINT PKWY",
            "address_2": "DEPT ANESTHESIOLOGY",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633682205",
            "telephone_number": "800-862-9980",
            "fax_number": "314-362-1185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "ROSE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-15",
        "last_updated": "2025-04-17",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2015011476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "910022184",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "2 Progress Point Pkwy",
            "address_2": "Dept Anesthesiology",
            "city": "O Fallon",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633682205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in O Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.