NPIMap

Individual provider Active NPI

Paige Nicole Sullivan

  • Physician Assistant
  • Utica, NY
National Provider Identifier
1649808411
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
025635 Issued in NY
Practice address
2211 Genesee St
Utica, NY 13501-5955
Phone
(315) 732-7598
NPI assigned
Mar 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 025635 NY Primary

Addresses

Primary practice location

2211 Genesee St
Utica, NY 13501-5955

Mailing address

PO Box 340
New Hartford, NY 13413-0340
Phone (315) 732-9368

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210426000501 NY Practitioner - Physician Assistant 1355759663 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central New York Cardiology, PCGroup PAC ID 3375530769, 28 clinicians

Practice addresses (Care Compare)

601 State St
Suite 200
Utica, NY 13502-4208
Phone (315) 733-7598

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.87 of 100Reported as group
Quality
78.81
Promoting interoperability
92
Improvement activities
40
Cost
74.48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
025635NYMDMassage Therapist

Organizations & group practices 1

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1585440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1649808411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 340",
            "city": "NEW HARTFORD",
            "state": "NY",
            "postal_code": "134130340",
            "telephone_number": "315-732-9368",
            "fax_number": "313-732-9403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 GENESEE ST",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135015955",
            "telephone_number": "315-732-7598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "PAIGE",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-29",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "025635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Utica, NY

Sources for this page

Verify at the official NPI Registry.