Active NPI
Patricia E Sullivan, MS, FNP
- Family Nurse Practitioner
- Chicago, IL
National Provider Identifier
1467744532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 209.001537
- Practice address
- 4646 N Marine Dr
Chicago, IL 60640-5759 - Phone
- (773) 878-8000
- NPI assigned
- May 9, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209.001537 | IL | Primary |
Addresses
Primary practice location
4646 N Marine Dr
Chicago, IL 60640-5759
Mailing address
4729 N Kenmore Ave
Unit 1
Chicago, IL 60640-5353
Phone (773) 699-7610
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.001537 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Resilience Healthcare - Lakefront Medical Associates, LLC | Current | Accepting new patients |
Locations
4646 N Marine Dr
Fl 3
Chicago, IL 60640
Phone (773) 564-6060
4646 N Marine Dr
Chicago, IL 60640
Phone (773) 564-5102
3 Erie Ct
Oak Park, IL 60302
Phone (708) 763-6200
7411 Lake St
Ste 1120
River Forest, IL 60305
Phone (708) 488-1490
Interoperability endpoints
- pat.sullivan.1@18552.direct.athenahealth.com
Organizations & group practices 1
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.
-
- General Practice Physician
- Chicago, IL
- NPI 1205301926
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304899200000",
"number": "1467744532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4729 N KENMORE AVE",
"address_2": "UNIT 1",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606405353",
"telephone_number": "773-699-7610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4646 N MARINE DR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606405759",
"telephone_number": "773-878-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "PATRICIA",
"middle_name": "E",
"name_prefix": "Ms.",
"credential": "MS, FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-09",
"last_updated": "2011-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209.001537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.