NPIMap

Individual provider Active NPI

Meagan A Sullivan-Pruyn, PA-C

  • Physician Assistant
  • Seattle, WA
National Provider Identifier
1689090722
Registry record updated Nov 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60435682 Issued in WA
Practice address
747 Broadway
Seattle, WA 98122
Phone
(206) 215-2520
Fax
(206) 386-3180
NPI assigned
Mar 13, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2019

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 PA60435682 WA Primary

Addresses

Primary practice location

747 Broadway
Seattle, WA 98122

Mailing address

PO Box 25608
Salt Lake City, UT 84125-0608
Phone (206) 320-4476

Other identifiers 1

IdentifierTypeStateIssuer
1689090722MedicaidWA

Other names 1

  • Meagan A Sullivan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20150528002706 WA Practitioner - Physician Assistant 0244454056 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedish Health ServicesGroup PAC ID 0244138196, 1,038 clinicians

Practice addresses (Care Compare)

21601 76TH Ave W
Edmonds, WA 98026-7507
Phone (425) 640-4000

500 17TH Ave
Seattle, WA 98122-5711
Phone (206) 320-2000

5300 Tallman Ave NW
Suite 2E
Seattle, WA 98107-3932
Phone (206) 781-6010

5300 Tallman Nwave
Seattle, WA 98107-3932
Phone (206) 782-2700

7320 216TH St SW
Edmonds, WA 98026-8006

747 Broadway
Seattle, WA 98122-4379
Phone (206) 386-6000

Hospital & facility affiliations

  • Swedish Medical Center Hospital, Seattle, WA, CCN 500027
  • Swedish Edmonds Hospital Hospital, Edmonds, WA, CCN 500026
  • Swedish Medical Center / Cherry Hill Hospital, Seattle, WA, CCN 500025
  • Jefferson Healthcare Hospital, Port Townsend, WA, CCN 501323

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA60435682WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Washington CurrentSince Apr 1, 2018 Accepting new patients
Providence Health & Services- Washington CurrentSince Apr 1, 2018 Accepting new patients
Swedish Health Services Past Accepting new patients

Locations

1700 13th St
Everett, WA 98201
Phone (425) 252-0895

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

747 Broadway
Seattle, WA 98122
Phone (360) 658-2488

Organizations & group practices 6

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 7

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": "1394668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1689090722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25608",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250608",
            "telephone_number": "206-320-4476",
            "fax_number": "206-568-7043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 BROADWAY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98122",
            "telephone_number": "206-215-2520",
            "fax_number": "206-386-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN-PRUYN",
        "first_name": "MEAGAN",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-13",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60435682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689090722",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MEAGAN",
            "last_name": "SULLIVAN",
            "middle_name": "A",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.