Michael Daris Sullivan, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5017901 Issued in NC

Practice address

225 Baldwin Ave
Charlotte, NC 28204-3109

Phone

(704) 376-1605

NPI assigned

Mar 21, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC, NC2 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, 2015

Medicare assignment

May accept Medicare assignment

Group practices

Carolina Neurosurgery and Spine Associates PAGroup PAC ID 7214833375, 104 clinicians

Comprehab, IncGroup PAC ID 2769653757, 376 clinicians

Atrium Health Neurospine Network LLCGroup PAC ID 1052800588, 121 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Caromont Regional Medical Center Hospital, Gastonia, NC, CCN 340032
• Atrium Health Cleveland Hospital, Shelby, NC, CCN 340021
• Atrium Health Lincoln Hospital, Lincolnton, NC, CCN 340145

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: msullivan1218144@carolinashealthcaresystem.direct-ci.com
• FHIR API: https://epicproxy.et0905.epichosted.com/FHIRProxy/api/FHIR/R4/

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.

• Atrium Health Neurospine Network LLC

  • Neurological Surgery Physician
  • Charlotte, NC
  • NPI 1033007695

  SC

  Medicare reassignment Care Compare group NPD
• Carolina Neurosurgery & Spine Associates PA

  • Neurological Surgery Physician
  • Charlotte, NC
  • NPI 1154384568

  SC

  Medicare reassignment Care Compare group NPD
• Comprehab LLC

  • Physical Therapist
  • Gastonia, NC
  • NPI 1407932775
  Care Compare group
• Atrium Health Neurospine Network LLC

  • Neurological Surgery Physician
  • Rock Hill, SC
  • NPI 1831081454
  NPD
• Carolina Neurosurgery & Spine Associates PA

  • Neurological Surgery Physician
  • Rock Hill, SC
  • NPI 1548819170
  NPD
• Carolina Neurosurgery, PA

  • Specialist
  • Greensboro, NC
  • NPI 1699737726
  NPD (past)

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

• Atrium Health Hospitals Inc

  • General Acute Care Hospital
  • Shelby, NC
  • NPI 1669348991
  Care Compare affiliation
• Atrium Health Hospitals Inc

  • General Acute Care Hospital
  • Lincolnton, NC
  • NPI 1730055054
  Care Compare affiliation
• Gaston Memorial Hospital, Incorporated

  • General Acute Care Hospital
  • Gastonia, NC
  • NPI 1013918960
  Care Compare affiliation

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

{
    "created_epoch": "1458518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708992000000",
    "number": "1679935514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 BALDWIN AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043109",
            "telephone_number": "704-376-1605",
            "fax_number": "704-335-8448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 BALDWIN AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043109",
            "telephone_number": "704-376-1605"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Richland Medical Park Dr",
            "address_2": "Suite 310",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292036849",
            "country_code": "US",
            "telephone_number": "803-434-8323",
            "fax_number": "803-434-8326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MICHAEL",
        "middle_name": "DARIS",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-21",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "20059",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5017901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679935514",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP4364",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "daris.sullivan.p1@direct.cnsa.nextshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "225 Baldwin Ave",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282043109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lauren Marie Sullivan, DO
• Meghan Marie Sullivan, CRNA
• Melanie Lee Dunn Sullivan, FNP-C
• Melissa Sullivan, PHARM.D.
• Melissa Evans Sullivan, NP
• Michael Douglas Sullivan, DC
• Michelle Julie Sullivan, DNP
• Morgan Sullivan, PHARMD
• Rachel Louise Sullivan, DPT
• Robert Jackson Sullivan III, MSW, LCSWA

• Family Nurse Practitioner in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.