Active NPI
Jeannine Balbiers Sullivan, RD
- Registered Dietitian
- Jamaica Plain, MA
National Provider Identifier
1508077264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 580
- Practice address
- 3297 Washington St
Jamaica Plain, MA 02130-2655 - Phone
- (617) 983-6050
- NPI assigned
- May 24, 2007
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 580 | MA | Primary |
Addresses
Primary practice location
3297 Washington St
Jamaica Plain, MA 02130-2655
Mailing address
70 Hope Ave
Suite 102
Waltham, MA 02453-2732
Phone (617) 983-6050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 580 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508077264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "70 HOPE AVE",
"address_2": "SUITE 102",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024532732",
"telephone_number": "617-983-6050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3297 WASHINGTON ST",
"city": "JAMAICA PLAIN",
"state": "MA",
"postal_code": "021302655",
"telephone_number": "617-983-6050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "JEANNINE",
"middle_name": "BALBIERS",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MA",
"license": "580",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamaica Plain, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.