Kelsi Sullivan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9116863 Issued in FL

Practice address

244 N Congress Ave # 2a
Boynton Beach, FL 33426-4212

Phone

(888) 760-4266

Fax

(203) 774-4636

NPI assigned

Jan 5, 2006

Last updated

Dec 2, 2023By 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 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MA, CA, FL, TN, NH, AZ, TX, VA, MD, CT, DC, MI, NV13 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 13

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

Locations

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.

• Img Medical Group de PA

  • Sports Medicine (Family Medicine) Physician
  • Boynton Beach, FL
  • NPI 1720708589

  AZ, DC, MD, NH, NV, TN, VA

  Medicare reassignment
• Img Medical Group TX, P.a.

  • Sports Medicine (Family Medicine) Physician
  • Dallas, TX
  • NPI 1619659760
  Medicare reassignment
• Sports Medicine North Orthopaedic Surgery, Inc.

  • Specialist
  • Peabody, MA
  • NPI 1760423719
  Medicare reassignment
• Img Medical Group Mi, P.C.

  • Sports Medicine (Family Medicine) Physician
  • Stamford, CT
  • NPI 1578308862
  Authorized official Same address or phone
• Sports Medicine North Orthopaedic Surgery, Inc

  dba Physical Therapy North

  • Multi-Specialty Clinic/Center
  • Gloucester, MA
  • NPI 1679168652
  NPD
• Conviva Medical Center Management LLC

  dba Conviva Care Center

  • Internal Medicine Physician
  • Miami, FL
  • NPI 1649324278
  NPD (past)

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701475200000",
    "number": "1669450144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 MORGAN CT",
            "city": "RYE",
            "state": "NH",
            "postal_code": "038702033",
            "telephone_number": "781-254-8837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 N CONGRESS AVE # 2A",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334264212",
            "telephone_number": "888-760-4266",
            "fax_number": "203-774-4636"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 Broad St",
            "address_purpose": "LOCATION",
            "city": "Stamford",
            "state": "CT",
            "postal_code": "069012004",
            "country_code": "US",
            "telephone_number": "781-254-8837",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9005 Overlook Blvd",
            "address_purpose": "LOCATION",
            "city": "Brentwood",
            "state": "TN",
            "postal_code": "370275269",
            "country_code": "US",
            "telephone_number": "888-760-4266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1045 Elm St Ste 204",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "NH",
            "postal_code": "031011844",
            "country_code": "US",
            "telephone_number": "888-760-4266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15333 N Pima Rd Ste 305",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852602717",
            "country_code": "US",
            "telephone_number": "888-760-4266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 N Saint Paul St Ste 3100",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752013923",
            "country_code": "US",
            "telephone_number": "888-760-4266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6200 Stoneridge Mall Rd Fl 3",
            "address_purpose": "LOCATION",
            "city": "Pleasanton",
            "state": "CA",
            "postal_code": "945883242",
            "country_code": "US",
            "telephone_number": "888-760-4266",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 Pembrook Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328106378",
            "country_code": "US",
            "telephone_number": "888-760-4266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELSI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-05",
        "last_updated": "2023-12-02",
        "certification_date": "2023-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "1536",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA16652",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MA",
            "license": "1536",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kassandra Suarez, APRN
• Rusty Suguitan
• Tamara Lynette Sukie, ARNP
• Daniel B. Sullivan, D.O.
• Jean Kiszka Sullivan, CRNA
• Stephanie Sullivan
• Summers Rain LLC
• Summerville 15, LLC (Brookdale West Boynton Beach)
• Summit Detox
• Summit Detox, Inc.

• Physician Assistant in Boynton Beach, FL
• Providers in Boynton Beach, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2023; 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.