Mary Janette Sullivan, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-077197 Issued in AL

Practice address

2100 Southbridge Pkwy Ste 650
Birmingham, AL 35209-1302

Phone

(205) 533-8902

Fax

(855) 737-5542

NPI assigned

Aug 12, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Janette Wilmoth Professional name

Medicare fee-for-service enrollment

Enrolled in AL

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

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centers for Developmentally Disabled, North Central AlGroup PAC ID 2668565938, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Centers for Developmentally Disabled, North Central Al

  • Family Nurse Practitioner
  • Decatur, AL
  • NPI 1740493436
  Medicare reassignment Care Compare group NPD
• Carelon Medical Partners of Kansas, PA

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Leawood, KS
  • NPI 1952831422
  NPD (past)

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

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554681600000",
    "number": "1356620009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 COMMERCE ST STE 700",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372011835",
            "telephone_number": "615-454-9850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 SOUTHBRIDGE PKWY STE 650",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352091302",
            "telephone_number": "205-533-8902",
            "fax_number": "855-737-5542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MARY",
        "middle_name": "JANETTE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-12",
        "last_updated": "2019-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-077197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "WILMOTH",
            "middle_name": "JANETTE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Edward Allen Sullivan III, M.D.
• James Gregory Sullivan, MD
• Joel Brent Sullivan, DO
• Karen Sullivan, CRNP
• Kimberly Allsopp Sullivan, CRNP
• Nicholas Cole Sullivan
• Paula Delane Sullivan, CRNP, BC
• Sharonda B Sullivan
• Tyler Briant Sullivan, MD
• Farah Taj Sultan, MD

• Family Nurse Practitioner in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2019; 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.
• 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.