Katie Jo Sullivan, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R166423 Issued in MD

Practice address

8579 Commerce Dr Ste 104
Easton, MD 21601-7420

Phone

(410) 822-9133

Fax

(410) 822-9513

NPI assigned

Nov 7, 2012

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 names 1

• Katie Jo Zimmerman Former name

Medicare fee-for-service enrollment

Enrolled in DC, MD2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Miles River Primary Care LLCGroup PAC ID 1951425545, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adoration Home Health Home health agency, Salisbury, MD, CCN 217111
• University of MD Shore Medical Center at Easton Hospital, Easton, MD, CCN 210037

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sullivan.katie.004.0200013@mrp.meditab.direct-ci.com

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.

• Miles River Primary Care LLC

  • Internal Medicine Physician
  • Easton, MD
  • NPI 1891015012
  Medicare reassignment Care Compare group NPD
• Minuteclinic LLC

  • Family Nurse Practitioner
  • Rockville, MD
  • NPI 1134191836

  DC

  Medicare reassignment NPD
• Miles River Primary Care LLC

  • Family Medicine Physician
  • Cambridge, MD
  • NPI 1699594044
  NPD (past)

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

• Amedisys Maryland LLC

  dba Adoration Home Health

  • Home Health Agency
  • Cambridge, MD
  • NPI 1811982069
  Care Compare affiliation Name & address match
• Shore Health System, Inc

  dba UM Shore Medical Center at Dorchester

  • General Acute Care Hospital
  • Cambridge, MD
  • NPI 1194784751
  Care Compare affiliation
• Shore Health System, Inc

  • Clinical Medical Laboratory
  • Easton, MD
  • NPI 1477513273

  Hospital

  Care Compare affiliation
• Shore Health System, Inc

  dba UM Shore Medical Center at Easton

  • General Acute Care Hospital
  • Easton, MD
  • NPI 1669431219
  Care Compare affiliation

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

{
    "created_epoch": "1352246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1649524059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8579 COMMERCE DR STE 104",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216017420",
            "telephone_number": "410-822-9133",
            "fax_number": "410-822-9513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8579 COMMERCE DR STE 104",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216017420",
            "telephone_number": "410-822-9133",
            "fax_number": "410-822-9513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "618 Sunburst Hwy",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MD",
            "postal_code": "216132546",
            "country_code": "US",
            "telephone_number": "667-327-0228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KATIE",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-07",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R166423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "ZIMMERMAN",
            "middle_name": "JO",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Donna Cunningham Stubbs, CRNP
• Morgan Taylor Stumpf, LMSW
• Rena Diana Sukhdeo Singh, MD
• Ayoub Suliman, PHARMD
• Antoinette Roth Sullivan, ED.D., LCPC, ACS
• Steven W Sullivan, PA-C
• Sunnyside Recovery, LLC
• Sunrise Counseling - Positive and Caring - It Is Your Time LLC (Sunrise Counseling - Positive and Caring -It Is Your Time)
• Surgery Center of Easton LP
• Susan Knade LLC

• Family Nurse Practitioner in Easton, MD
• Providers in Easton, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; 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.