Individual provider Active NPI

Kristine Sullivan, NP

  • Nurse Practitioner
  • Ithaca, NY
National Provider Identifier
1336799899
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
345036 Issued in NY
Practice address
101 Dates Dr
Ithaca, NY 14850-1342
Phone
(607) 274-4011
NPI assigned
Sep 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F345036 NY
Nurse Practitioner 363L00000X 345036 NY Primary

Addresses

Primary practice location

101 Dates Dr
Ithaca, NY 14850-1342

Mailing address

101 Dates Dr
Ithaca, NY 14850-1342

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20191108000269 NY Practitioner - Nurse Practitioner 8022440205 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cayuga Medical Associates PCGroup PAC ID 6709897960, 278 clinicians

Practice addresses (Care Compare)

101 Dates Dr
Ithaca, NY 14850-1342
Phone (607) 274-4296

Hospital & facility affiliations

  • Cayuga Medical Center at Ithaca Hospital, Ithaca, NY, CCN 330307

Merit-based Incentive Payment System (MIPS)

Final score
94.27 of 100Reported as apm
Quality
82.87
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F345036NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cayuga Medical Associates, PC CurrentSince Aug 3, 2020 Accepting new patients
The Unity Hospital of Rochester CurrentSince Oct 1, 2019 Accepting new patients
Rochester General Hospital CurrentSince Oct 1, 2019 Accepting new patients
Newark Wayne Community Hospital CurrentSince Oct 1, 2019 Accepting new patients
United Memorial Medical Center CurrentSince Oct 1, 2019 Accepting new patients
Newark Wayne Community Hospital CurrentSince Oct 1, 2019 Accepting new patients
The Unity Hospital of Rochester Current Accepting new patients
Rochester General Hospital CurrentSince Oct 1, 2019 Accepting new patients
Clifton Springs Sanitarium Co CurrentSince Oct 1, 2019 Accepting new patients
United Memorial Medical Center Current Accepting new patients
Western New York Medical Practice P.C. CurrentSince Oct 1, 2019 Accepting new patients

Locations

16 Bank St
Batavia, NY 14020
Phone (585) 344-4800

229 Summit St
Ste 1
Batavia, NY 14020
Phone (585) 343-4440

2 Coulter Rd
Clifton Springs, NY 14432
Phone (315) 462-1472

101 Harris B Dates Dr
Ithaca, NY 14850
Phone (607) 274-4011

310 Taughannock Blvd
Fl 4
Ithaca, NY 14850
Phone (607) 269-0100

1200 Driving Park Ave
Newark, NY 14513
Phone (315) 332-2266

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

1555 Long Pond Rd
Rochester, NY 14626
Phone (585) 429-2289

1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122

Organizations & group practices 11

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": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1336799899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 DATES DR",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DATES DR",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501342",
            "telephone_number": "607-274-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KRISTINE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-17",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F345036",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "345036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

Verify at the official NPI Registry.