Pamela Sue Sullivan, GNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

12764 Issued in CA

Practice address

40055 Bob Hope Dr Ste B
Rancho Mirage, CA 92270-3940

Phone

(760) 202-3946

Fax

(760) 770-4392

NPI assigned

Mar 26, 2007

Last updated

Jul 21, 2022By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

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

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Paragon Chico Medical Group, Inc

  • Radiation Oncology Physician
  • Chico, CA
  • NPI 1528527181
  Medicare reassignment NPD
• San Gorgonio Memorial Hospital

  • General Acute Care Hospital
  • Banning, CA
  • NPI 1568469997
  NPD (past)

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1336267699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 COLONIAL BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071410",
            "telephone_number": "239-931-7342",
            "fax_number": "239-931-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40055 BOB HOPE DR STE B",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922703940",
            "telephone_number": "760-202-3946",
            "fax_number": "760-770-4392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "PAMELA",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "GNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "CA",
            "license": "262478",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "12764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1409819",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4984336",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcos Antonio Suarez, M.D.
• Cari Lynn Sudmeier, NP
• Mehreen Sulaiman, DMD
• Montee A Suleiman, MD
• Katherine Josephine Sullivan, PT
• Starr Sullivan, LMFT
• Superior, Inc (Advanced Hearing Systems)
• Surender Vuthoori MD Inc
• Sienna Jean Sutton
• Suzanne M Quardt MD Inc (Dr Q Plastic Surgery)

• Gerontology Nurse Practitioner in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Gerontology Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.