Individual provider Active NPI

Melissa Evans Sullivan, NP

  • Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1396792693
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5000605 Issued in NC
Practice address
1350 S Kings Dr
Charlotte, NC 28207-2134
Phone
(704) 446-1422
NPI assigned
May 30, 2006
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 5000605 NC
Nurse Practitioner 363L00000X 5000605 NC Primary

Addresses

Primary practice location

1350 S Kings Dr
Charlotte, NC 28207-2134

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

3193 W Highway 74
Monroe, NC 28110-8437
Phone (704) 698-4089

Other practice location 2

6025 Blakeney Park Dr
Ste 100
Charlotte, NC 28277-5703
Phone (704) 667-4480

Other practice location 3

231 S Sharon Amity Rd
Charlotte, NC 28211-2803
Phone (704) 304-6400

Other practice location 4

1001 Blythe Blvd
Medical Center Plaza, Suite 200
Charlotte, NC 28203-5866
Phone (704) 381-8840

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address msullivan57283@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20050909000592 NC Practitioner - Nurse Practitioner 5193757193 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center CurrentSince Jun 17, 2013 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Nov 11, 2022 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Nov 11, 2022 Accepting new patients
Carolinas Medical Center CurrentSince Jun 17, 2013 Accepting new patients
Mid-Atlantic Emergency Medical Associates, PLLC Past Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

6025 Blakeney Park Dr
Ste 100
Charlotte, NC 28277
Phone (704) 667-4480

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

231 S Sharon Amity Rd
Charlotte, NC 28211
Phone (704) 304-6400

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

1001 Blythe Blvd
Ste 200
Charlotte, NC 28203
Phone (704) 373-0544

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

1350 S Kings Dr
Charlotte, NC 28207
Phone (704) 446-1255

3193 W Highway 74
Monroe, NC 28110
Phone (704) 689-4089

Interoperability endpoints

  • Direct secure messaging: msullivan57283@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 7

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1396792693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 S KINGS DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282072134",
            "telephone_number": "704-446-1422"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3193 W Highway 74",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "NC",
            "postal_code": "281108437",
            "country_code": "US",
            "telephone_number": "704-698-4089",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6025 Blakeney Park Dr",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282775703",
            "country_code": "US",
            "telephone_number": "704-667-4480",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "231 S Sharon Amity Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282112803",
            "country_code": "US",
            "telephone_number": "704-304-6400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 Blythe Blvd",
            "address_2": "Medical Center Plaza, Suite 200",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035866",
            "country_code": "US",
            "telephone_number": "704-381-8840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MELISSA",
        "middle_name": "EVANS",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-30",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5000605",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5000605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msullivan57283@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1350 S Kings Dr",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282072134",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.