NPIMap

Individual provider Active NPI

John Thomas Sullivan, PA-C

  • Physician Assistant
  • Greensburg, PA
National Provider Identifier
1407056708
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6307 Issued in AZ
Practice address
522 W Newton St Ste 300
Greensburg, PA 15601-2890
Phone
(724) 838-7500
Fax
(724) 837-6670
NPI assigned
Jul 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 6307 AZ Primary

Addresses

Primary practice location

522 W Newton St Ste 300
Greensburg, PA 15601-2890

Mailing address

4811 E Grant Rd Ste 261
Tucson, AZ 85712-2776
Phone (520) 618-1010

Other identifiers 1

IdentifierTypeStateIssuer
113349MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260205003138 PA Practitioner - Physician Assistant 8224295613 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Mellon Way
Latrobe, PA 15650-1197
Phone (724) 537-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1652MNMDNeonatal/Pediatric Registered Respiratory Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Excela Health Physician Practices, Inc. CurrentSince Feb 1, 2026 Accepting new patients
Excela Health Physician Practices, Inc. CurrentSince Feb 1, 2026 Accepting new patients
Mayo Clinic Past Accepting new patients
Excela Health Physician Practices, Inc Past Accepting new patients

Locations

532 W Pittsburgh St
Greensburg, PA 15601
Phone (724) 832-4000

522 W Newton St
Ste 300
Greensburg, PA 15601
Phone (724) 838-7500

1 Mellon Way
Latrobe, PA 15650
Phone (724) 537-1207

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 and National Provider Directory roles.

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1407056708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 E GRANT RD STE 261",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122776",
            "telephone_number": "520-618-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 W NEWTON ST STE 300",
            "city": "GREENSBURG",
            "state": "PA",
            "postal_code": "156012890",
            "telephone_number": "724-838-7500",
            "fax_number": "724-837-6670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JOHN",
        "middle_name": "THOMAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-24",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113349",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensburg, PA

Sources for this page

Verify at the official NPI Registry.