Wamaitha Sullivan, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

277000092 Issued in IL

Practice address

1120 N Melvin St
Gibson City, IL 60936-1477

Phone

(217) 379-4864

NPI assigned

Sep 30, 2009

Sex

Female

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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

First Docs PCGroup PAC ID 0547626871, 181 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wamaitha.sullivan.p5@direct.gapho.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.

• First Docs PC

  • Internal Medicine Physician
  • Naperville, IL
  • NPI 1417655465
  Medicare reassignment Care Compare group NPD
• Community Health Partnership of Illinois

  • Federally Qualified Health Center (FQHC)
  • Aurora, IL
  • NPI 1932375169
  Medicare reassignment NPD
• Community Health Partnership of Illinois

  • Federally Qualified Health Center (FQHC)
  • Princeville, IL
  • NPI 1336767540
  NPD
• Community Health Partnership of Illinois

  • Federally Qualified Health Center (FQHC)
  • Kankakee, IL
  • NPI 1982870259
  NPD (past)

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

{
    "created_epoch": "1254268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1689908220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 N MELVIN ST",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361477",
            "telephone_number": "217-379-4864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 N MELVIN ST",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361477",
            "telephone_number": "217-379-4864"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "819 Bloomington Rd",
            "address_purpose": "LOCATION",
            "city": "Champaign",
            "state": "IL",
            "postal_code": "618202101",
            "country_code": "US",
            "telephone_number": "217-356-1558",
            "fax_number": "217-356-1558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "WAMAITHA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-30",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209007740",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277000092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370647938007",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wamaitha.sullivan.p5@direct.gapho.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1120 N Melvin St",
            "city": "Gibson City",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609361477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mark M Spangler, MD
• Sheree Stachura, JD, MSN, APRN,FNP-BC
• Kacy Marie Standiford, PA-C
• Jennifer Sterrenberg
• Brooke Rachelle Stewart, FNP-C
• Malcolm Taylor, ATC
• Summer Taylor
• Denise Thornton
• Ivonne Marie Torres Baez, MD
• Katelyn Belle Van Vickle, LSW

• Family Nurse Practitioner in Gibson City, IL
• Providers in Gibson City, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2025; 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.