Active NPI
Cynthia Rowley-Sullivan, PA
- Physician Assistant
- Coal Valley, IL
National Provider Identifier
1639142458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085002201
- Practice address
- 104 W 18TH Ave
Coal Valley, IL 61240-9337 - Phone
- (309) 799-7518
- Fax
- (309) 799-3886
- NPI assigned
- Feb 10, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085002201 | IL | Primary |
Addresses
Primary practice location
104 W 18TH Ave
Coal Valley, IL 61240-9337
Mailing address
104 W 18TH Ave
Coal Valley, IL 61240-9337
Phone (309) 799-7518
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639142458 | Medicaid | IL | |
| 93342 | Other | IL | BCWELLMARK NUMBER |
| IL01W4 | Other | IL | JOHN DEERE NUMBER |
| 362739299001 | Other | IL | TRICARE NUMBER |
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085002201 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389744000000",
"number": "1639142458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 W 18TH AVE",
"city": "COAL VALLEY",
"state": "IL",
"postal_code": "612409337",
"telephone_number": "309-799-7518",
"fax_number": "309-799-3886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 W 18TH AVE",
"city": "COAL VALLEY",
"state": "IL",
"postal_code": "612409337",
"telephone_number": "309-799-7518",
"fax_number": "309-799-3886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROWLEY-SULLIVAN",
"first_name": "CYNTHIA",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-10",
"last_updated": "2014-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085002201",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1639142458",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCWELLMARK NUMBER",
"identifier": "93342",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE NUMBER",
"identifier": "IL01W4",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE NUMBER",
"identifier": "362739299001",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coal Valley, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.