Mary A Sullivan, PCNS

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

21544 Issued in CA

Practice address

50 Maude St
Providence, RI 02908-4325

Phone

(401) 456-2000

Fax

(401) 456-6554

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Specialist, Nurse Practitioner

State licenses

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.

• Telecare Corporation

  dba Gateway To Recovery

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Diego, CA
  • NPI 1720164882
  Medicare reassignment NPD
• Telecare Corporation

  dba Valley Vista Permanent Supportive Housing

  • Mental Illness Community Based Residential Treatment Facility
  • San Diego, CA
  • NPI 1275398935
  NPD
• Telecare Corporation

  • Psychiatric Residential Treatment Facility
  • San Leandro, CA
  • NPI 1407232564
  NPD
• Elmhurst Extended Care Facilities, Inc.

  • Skilled Nursing Facility
  • Providence, RI
  • NPI 1164467221
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328140800000",
    "number": "1386662484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 MAUDE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084325",
            "telephone_number": "401-456-2000",
            "fax_number": "401-456-6554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MAUDE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084325",
            "telephone_number": "401-456-2000",
            "fax_number": "401-456-6554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MARY",
        "middle_name": "A",
        "credential": "PCNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2012-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "RI",
            "license": "PPNS00073",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "21544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James C Sullivan, MD
• Kelli Lynn Sullivan, PHD
• Kevin Sullivan, RN
• Madison Sullivan
• Mallory Sullivan, PA
• Patricia Leigh Zadnik Sullivan, M.D.
• Patrick Sullivan, MD
• Patrick B. Sullivan, M.D.
• Rachel Aileen Sullivan, MD
• Rachel R Sullivan

• Gerontology Nurse Practitioner in Providence, RI
• Providers in Providence, RI by specialty
• Gerontology Nurse Practitioner in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; 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.