Individual provider Active NPI

Sabra Sullivan, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • West Springfield, MA
National Provider Identifier
1366875437
Registry record updated Aug 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN284172 Issued in MA
Practice address
103 Myron St
Suite a
West Springfield, MA 01089-1598
Phone
(413) 592-1980
Fax
(413) 439-0100
NPI assigned
Aug 13, 2013
Last updated
Aug 13, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN284172 MA Primary

Addresses

Primary practice location

103 Myron St
Suite a
West Springfield, MA 01089-1598

Mailing address

90 Undine Rd
Apt. 1
Brighton, MA 02135-3812
Phone (508) 951-6632

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20131021000142 MA Practitioner - Nurse Practitioner 3476788894 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The McLean Hospital CorporationGroup PAC ID 9436040961, 186 clinicians

Practice addresses (Care Compare)

115 Mill St
Belmont, MA 02478-1064
Phone (617) 855-3450

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The McLean Hospital Corporation CurrentSince Aug 22, 2022 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Mar 28, 2014 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Mar 28, 2014 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Mar 28, 2014 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Mar 28, 2014 Accepting new patients

Locations

115 Mill St
Belmont, MA 02478
Phone (617) 855-2000

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

23 Isaac St
Middleboro, MA 02346
Phone (774) 419-1000

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1376352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376352000000",
    "number": "1366875437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 UNDINE RD",
            "address_2": "APT. 1",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021353812",
            "telephone_number": "508-951-6632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 MYRON ST",
            "address_2": "SUITE A",
            "city": "WEST SPRINGFIELD",
            "state": "MA",
            "postal_code": "010891598",
            "telephone_number": "413-592-1980",
            "fax_number": "413-439-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SABRA",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-13",
        "last_updated": "2013-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN284172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Springfield, MA

Sources for this page

Verify at the official NPI Registry.