Therese Eileen Sullivan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085003070 Issued in IL

Practice address

47 Brookside Dr
Lemont, IL 60439-7709

Phone

(630) 257-8428

NPI assigned

Sep 27, 2007

Last updated

Sep 27, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Emergency Medicine Professionals PA

  • Emergency Medicine Physician
  • Deland, FL
  • NPI 1205880853
  Medicare reassignment
• Center for Minimally Invasive Therapies, LLC

  • Point of Service
  • Melrose Park, IL
  • NPI 1548308380
  NPD (past)
• Rapid City Indian Health Service Hospital

  • General Acute Care Hospital
  • Rapid City, SD
  • NPI 1316900327
  NPD (past)

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

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190851200000",
    "number": "1629265251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 BROOKSIDE DR",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604397709",
            "telephone_number": "630-257-8428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 BROOKSIDE DR",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604397709",
            "telephone_number": "630-257-8428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "THERESE",
        "middle_name": "EILEEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-27",
        "last_updated": "2007-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Stoklosa, APN
• Chris Stout, PSYD
• Raymond Charles Strzykalski, MSW, LCSW
• Suburban Medi-Van, Inc.
• Joel Suchecki, A.T.C.
• Tamara Pike LTD
• That Foodie Dietitian LLC
• Dana Marie Threet, MS
• Timberline Knolls LLC
• Timberline Knolls, LLC

• Physician Assistant in Lemont, IL
• Providers in Lemont, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.