Amanda Renee Sullivan, AGACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

11297 Issued in WI

Practice address

9200 W Wisconsin Ave
Milwaukee, WI 53226-3522

Phone

(414) 805-4050

Fax

(414) 805-0855

NPI assigned

Aug 30, 2021

Sex

Female

Sole proprietor

No

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

• Ms. Amanda Renee Ward Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Merit-based Incentive Payment System (MIPS)

Final score

87.99 of 100Reported as group

Quality

82.81

Promoting interoperability

100

Improvement activities

40

Cost

77.15

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: award406284@direct.froedtert.com

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1538837166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-4050",
            "fax_number": "414-805-0855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-805-4050",
            "fax_number": "414-805-0855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "AMANDA",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "AGACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-30",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "WI",
            "license": "11297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538837166",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "WARD",
            "middle_name": "RENEE",
            "prefix": "MS.",
            "credential": "AGACNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Abdullattief Abdulaziz Sulieman, M.D.
• Sullivan Medical Clinic, LLC
• Lisa A Sullivan Vedder, MD
• Catherine Sullivan-Konyn, MSW, APSW
• Martina M Sullivan-Konyn, RN
• Bridget Rose Gross Sullivan, M.D.
• Connor William Sullivan, M.D.
• Cristina Marie Soto Sullivan, PHD
• Dennis M Sullivan, MD
• Gerald Edward Sullivan, M.D.

• Acute Care Nurse Practitioner in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Acute Care Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; 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.