Jacqueline Yvonne Sullivan, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

MW010272 Issued in PA

Practice address

1165 Imperial Dr Ste 200
Hagerstown, MD 21740-6583

Phone

(301) 665-9098

Fax

(301) 665-9096

NPI assigned

Mar 1, 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 identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA, MD2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jsullivan133389@wellspan.direct-ci.com
• Direct secure messaging: jaqueline.sullivan.p1@direct.cwcare.nextgenshare.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.

• Capital Women's Care, L.L.C.

  • Obstetrics & Gynecology Physician
  • Fulton, MD
  • NPI 1679534069
  Medicare reassignment NPD
• Wellspan Medical Group

  dba WellSpan Digestive Health

  • Gastroenterology Physician
  • York, PA
  • NPI 1669770004
  Medicare reassignment NPD
• Capital Women's Care, L.L.C.

  dba Frederick OB/GYN Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Frederick, MD
  • NPI 1093766289
  NPD
• Wellspan Medical Group

  dba WellSpan Pediatric Surgical Specialist

  • Pediatric Surgery Physician
  • York, PA
  • NPI 1104799428
  NPD
• Wellspan Medical Group

  • Gastroenterology Physician
  • Lebanon, PA
  • NPI 1578014007
  NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1330560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1679847107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8110 MAPLE LAWN BLVD STE 235",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592694",
            "telephone_number": "301-340-8339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 IMPERIAL DR STE 200",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406583",
            "telephone_number": "301-665-9098",
            "fax_number": "301-665-9096"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "214 Peach Orchard Rd",
            "address_purpose": "LOCATION",
            "city": "Mc Connellsburg",
            "state": "PA",
            "postal_code": "172338559",
            "country_code": "US",
            "telephone_number": "717-485-6125",
            "fax_number": "717-485-6106",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 E Main St",
            "address_purpose": "LOCATION",
            "city": "Waynesboro",
            "state": "PA",
            "postal_code": "172682332",
            "country_code": "US",
            "telephone_number": "717-765-5086",
            "fax_number": "717-762-4551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24 Antrim Commons Dr",
            "address_purpose": "LOCATION",
            "city": "Greencastle",
            "state": "PA",
            "postal_code": "172251623",
            "country_code": "US",
            "telephone_number": "717-765-5086",
            "fax_number": "717-597-5522",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "97 Progress Blvd",
            "address_purpose": "LOCATION",
            "city": "Shippensburg",
            "state": "PA",
            "postal_code": "172579053",
            "country_code": "US",
            "telephone_number": "717-217-6882",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 N 7th St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Chambersburg",
            "state": "PA",
            "postal_code": "172011795",
            "country_code": "US",
            "telephone_number": "717-217-6882",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12 St Paul Dr Ste 207",
            "address_purpose": "LOCATION",
            "city": "Chambersburg",
            "state": "PA",
            "postal_code": "172011035",
            "country_code": "US",
            "telephone_number": "717-217-6882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JACQUELINE",
        "middle_name": "YVONNE",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-01",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "PA",
            "license": "MW010272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102733511",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jaqueline.sullivan.p1@direct.cwcare.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1165 Imperial Dr Ste 200",
            "city": "Hagerstown",
            "state": "MD",
            "country_code": "US",
            "postal_code": "217406583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Daniel Jose Suarez, LMSW
• Marett Subrizi, RN
• Sufi Acupuncture and Healing
• Casey Seton Sullivan, RN
• Diane Brasher Sullivan, LCSW
• Luther Boyd Sullivan
• Mark F Sullivan Sr., MD
• Bradley Sultan
• Jennifer Anne Suminski, CPHT
• Ashton Elizabeth Summers, MS- LCPC

• Advanced Practice Midwife in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Advanced Practice Midwife in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.