Jessica Page Sullivan, CRNP-PMH

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R192427 Issued in MD

Practice address

10 W Madison St Ste 11
Baltimore, MD 21201

Phone

(443) 438-7863

NPI assigned

Aug 13, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jessica Lynne Page Former name

Medicare fee-for-service enrollment

Enrolled in MD

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Complete Wellness, Inc.Group PAC ID 5496096489, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Complete Wellness, Inc.

  • Community/Behavioral Health Agency
  • Baltimore, MD
  • NPI 1912336934
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534377600000",
    "number": "1508265737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 W MADISON ST STE 11",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212012313",
            "telephone_number": "443-438-7863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 W MADISON ST STE 11",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21201",
            "telephone_number": "443-438-7863"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13639 Baltimore Ave",
            "address_purpose": "LOCATION",
            "city": "Laurel",
            "state": "MD",
            "postal_code": "207075095",
            "country_code": "US",
            "telephone_number": "301-604-4830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JESSICA",
        "middle_name": "PAGE",
        "credential": "CRNP-PMH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-13",
        "last_updated": "2018-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R192427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086453600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "PAGE",
            "middle_name": "LYNNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Sullivan, M.D.
• Eleanor Margaret Sullivan
• Holly Lynn Sullivan, CCC-SP
• Jacqueline Rose Sullivan, PA
• Jada Sullivan
• Kammie Lynnette Sullivan, OTR/L
• Kathleen D Sullivan, LCPC
• Kelsey Sullivan
• Marlysa Sullivan, PT
• Maryam A Sullivan

• Psychiatric/Mental Health Nurse Practitioner in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.