Individual provider Active NPI

Emily Sullivan Martin, ARNP

  • Nurse Practitioner
  • Gainesville, FL
National Provider Identifier
1285017616
Registry record updated Jul 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9308027 Issued in FL
Practice address
1600 SW Archer Rd
Pediatric Heart and Lung Transplant
Gainesville, FL 32610-0223
Phone
(352) 265-0665
Fax
(352) 265-0057
NPI assigned
Jul 2, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9308027 FL Primary

Addresses

Primary practice location

1600 SW Archer Rd
Pediatric Heart and Lung Transplant
Gainesville, FL 32610-0223

Mailing address

PO Box 100223
Gainesville, FL 32610-0223
Phone (352) 265-0665

Other identifiers 1

IdentifierTypeStateIssuer
016017000MedicaidFL

Other names 1

  • Emily Ellen Sullivan Other name

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20151121000294 FL Practitioner - Nurse Practitioner 2769782887 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9308027FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Oct 5, 2015 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Oct 5, 2015 Accepting new patients

Locations

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

Interoperability endpoints

  • Direct secure messaging: esullivan14584@direct.shands.ufl.edu

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.

NPI Registry JSON

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500249600000",
    "number": "1285017616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100223",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100223",
            "telephone_number": "352-265-0665",
            "fax_number": "352-265-0057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "address_2": "PEDIATRIC HEART AND LUNG TRANSPLANT",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100223",
            "telephone_number": "352-265-0665",
            "fax_number": "352-265-0057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "EMILY",
        "middle_name": "SULLIVAN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-02",
        "last_updated": "2017-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "9308027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016017000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "SULLIVAN",
            "middle_name": "ELLEN",
            "credential": "ARNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.