Bonnie Sullivan

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

LL-92472 Issued in SC

Practice address

876 W Faris Rd
Greenville, SC 29605-4253

Phone

(864) 455-5648

NPI assigned

Mar 28, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1711584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1255182358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "876 W FARIS RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "876 W FARIS RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054253",
            "telephone_number": "864-455-5648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "BONNIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-28",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "LL-92472",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL-92472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chandra Sugalski, M.ED., NCC, LPC
• James Hartman Suhrer Jr., MD
• Frederick John Suhrstedt III, MD
• Sullivan Professional Services
• Asheley Sullivan
• Emily Wilson Sullivan, OTR
• Jeffery Sullivan
• Jennifer Winkler Sullivan, CNM
• Jill Maxwell Sullivan, M.D.
• Latasha G Sullivan

• Internal Medicine Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Internal Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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.