Individual provider Active NPI

Theresia Sutherlin, MD

  • Child & Adolescent Psychiatry Physician
  • Philadelphia, PA
National Provider Identifier
1417416348
Registry record updated Dec 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
MD487066 Issued in PA
Practice address
4601 Market St FL 3
Philadelphia, PA 19139-4636
Phone
(215) 590-6267
NPI assigned
Mar 19, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 336008 LA
Student in an Organized Health Care Education/Training Program 390200000X
Child & Adolescent Psychiatry Physician 2084P0804X MD487066 PA Primary

Addresses

Primary practice location

4601 Market St FL 3
Philadelphia, PA 19139-4636

Mailing address

1430 Tulane Ave # 8055
New Orleans, LA 70112-2632
Phone (504) 988-7829

Other practice location 1

111 Michigan Ave NW
Washington, DC 20010-2916
Phone (202) 476-3277

Other practice location 2

1430 Tulane Ave # 8055
New Orleans, LA 70112-2632
Phone (504) 988-7829

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, ME2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241212000132 DC Practitioner - NeurologyPractitioner - Psychiatry 1557897691 Reassigns benefits to 1 organization
I20251016003126 ME Practitioner - Psychiatry 1557897691 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Tulane University School of Medicine, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

268 Stillwater Ave
Bangor, ME 04401-3945

268 Stillwater Ave
Bangor, ME 04401-3980

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
336008LAMDChild & Adolescent Psychiatry Physician
MD487066PAMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital CurrentSince Sep 9, 2024 Accepting new patients
Children'S Hospital CurrentSince Sep 9, 2024 Accepting new patients
Acadia Hospital Corp CurrentSince Sep 14, 2025 Accepting new patients
Children'S Hospital Current Accepting new patients

Locations

111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670

268 Stillwater Ave
Bangor, ME 04401
Phone (207) 973-6470

Organizations & group practices 4

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": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1417416348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 TULANE AVE # 8055",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701122632",
            "telephone_number": "504-988-7829",
            "fax_number": "504-988-4264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 MARKET ST FL 3",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191394636",
            "telephone_number": "215-590-6267"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Michigan Ave NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200102916",
            "country_code": "US",
            "telephone_number": "202-476-3277",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1430 Tulane Ave # 8055",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "701122632",
            "country_code": "US",
            "telephone_number": "504-988-7829",
            "fax_number": "504-988-4264",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUTHERLIN",
        "first_name": "THERESIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-19",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "LA",
            "license": "336008",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "PA",
            "license": "MD487066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.