Individual provider Active NPI

Patricia E Sullivan, MS, FNP

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1467744532
Registry record updated May 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.001537 Issued in IL
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

Updated by the provider on May 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240312001214 IL Practitioner - Nurse Practitioner 6305282401 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
209.001537ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Resilience Healthcare - Lakefront Medical Associates, LLC CurrentSince Jan 28, 2024 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.