Jerry Sullivan, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

004285 Issued in GA

Practice address

2225 US Highway 41 N
Tifton, GA 31794-2749

Phone

(229) 391-4100

NPI assigned

Sep 2, 2005

Last updated

Apr 6, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tift Regional Health System IncGroup PAC ID 2062745169, 294 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tift Regional Medical Center Hospital, Tifton, GA, CCN 110095
• Southwell Medical, a Campus of TRMC Hospital, Adel, GA, CCN 110101

Merit-based Incentive Payment System (MIPS)

Final score

81.02 of 100Reported as group

Quality

57.87

Promoting interoperability

100

Improvement activities

40

Cost

75.97

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jerry.sullivan@trhs.cernerdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tift Regional Health System Inc

  dba Southwell Mobile Clinic

  • Family Medicine Physician
  • Tifton, GA
  • NPI 1881203305
  Medicare reassignment Care Compare group
• Tift Regional Health System Inc

  dba WorkSmart Occupational Medicine

  • Clinic/Center
  • Tifton, GA
  • NPI 1003980996
  NPD
• Tift Regional Health System Inc

  dba Tift Regional Vascular

  • Vascular Surgery Physician
  • Tifton, GA
  • NPI 1184080079
  NPD
• Tift Regional Health System, Inc

  dba Southwell Medical Clinic

  • Multi-Specialty Clinic/Center
  • Tifton, GA
  • NPI 1861022329
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Tift Regional Health System Inc.

  dba Tift Regional Medical Center

  • General Acute Care Hospital
  • Tifton, GA
  • NPI 1962462226
  Care Compare affiliation
• Tift Regional Health System, Inc.

  dba Southwell Medical

  • General Acute Care Hospital
  • Adel, GA
  • NPI 1568410264
  Care Compare affiliation

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1629062724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 18TH ST E STE 400",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943684",
            "telephone_number": "229-391-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 US HIGHWAY 41 N",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317942749",
            "telephone_number": "229-391-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JERRY",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jerry.sullivan@trhs.cernerdirect.com",
            "affiliation": "N",
            "address_1": "2225 US Highway 41 N",
            "city": "Tifton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317942749",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Teresa C Stewart, MD
• Wayne T Stewart, MD
• Robin A Stoecker, D.O.
• Deborah C Stokes, DO
• Sandra Melinda Stone, RN, MSN, FNP-C
• Margaret Lee Sullivan, LMT, CMT
• Katelyn Sumner, RBT
• Kaylee Cheyenne Sumner, PHARMD
• Laura Sumner, MSN-FNP
• Surgery Center at Cypress Point LLC

• Medical Physician Assistant in Tifton, GA
• Providers in Tifton, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; 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.