Individual provider Active NPI

Kayla Marie Sullivan, FNP-BC

  • Obstetrics & Gynecology Nurse Practitioner
  • Quincy, MA
National Provider Identifier
1376393181
Registry record updated Sep 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
RN2334358 Issued in MA
Practice address
1250 Hancock St
Quincy, MA 02169-4339
Phone
(617) 774-0600
NPI assigned
Mar 25, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN2334358 MA
Obstetrics & Gynecology Nurse Practitioner 363LX0001X RN2334358 MA Primary

Addresses

Primary practice location

1250 Hancock St
Quincy, MA 02169-4339

Mailing address

1250 Hancock St
Quincy, MA 02169-4339
Phone (617) 774-0600

Other practice location 1

330 Mount Auburn St
Cambridge, MA 02138-5597
Phone (617) 492-3500

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
I20241101003045 MA Practitioner - Nurse Practitioner 7719410471 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atrius Health IncGroup PAC ID 4789588641, 1,214 clinicians

Practice addresses (Care Compare)

1250 Hancock St
Quincy, MA 02169-4339
Phone (617) 740-0600

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Atrius Health, Inc. CurrentSince Dec 30, 2024 Accepting new patients
Atrius Health, Inc. Current Accepting new patients

Locations

133 Brookline Ave
Boston, MA 02215
Phone (617) 421-1000

147 Milk St
Fl 9
Boston, MA 02109
Phone (617) 559-8051

1250 Hancock St
Quincy, MA 02169
Phone (617) 774-0600

Interoperability endpoints

  • Direct secure messaging: ksullivannp394774@direct.atrius.masshiway.net

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": "1711324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1376393181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 HANCOCK ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021694339",
            "telephone_number": "617-774-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 HANCOCK ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021694339",
            "telephone_number": "617-774-0600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 Mount Auburn St",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MA",
            "postal_code": "021385597",
            "country_code": "US",
            "telephone_number": "617-492-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KAYLA",
        "middle_name": "MARIE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-25",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MA",
            "license": "RN2334358",
            "primary": false
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "MA",
            "license": "RN2334358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

Verify at the official NPI Registry.