Kimberly Ann Sullivan, P.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

C0003687 Issued in MD

Practice address

100 Rawlins Dr
Seaford, DE 19973-5881

Phone

(302) 990-3280

Fax

(302) 990-3290

NPI assigned

Sep 14, 2009

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

Medicare fee-for-service enrollment

Enrolled in DE

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

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tidalhealth Physician Network, Inc.Group PAC ID 7315901253, 115 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tidalhealth Nanticoke, Inc. Hospital, Seaford, DE, CCN 080006

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Tidalhealth Physician Network, Inc.

  • Family Medicine Physician
  • Seaford, DE
  • NPI 1467534636
  Medicare reassignment Care Compare group

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

• Tidalhealth Nanticoke, Inc

  • General Acute Care Hospital
  • Seaford, DE
  • NPI 1245214477
  Care Compare affiliation

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

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543536000000",
    "number": "1699008359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RAWLINS DR",
            "city": "SEAFORD",
            "state": "DE",
            "postal_code": "199735881",
            "telephone_number": "302-990-3280",
            "fax_number": "302-990-3290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RAWLINS DR",
            "city": "SEAFORD",
            "state": "DE",
            "postal_code": "199735881",
            "telephone_number": "302-990-3280",
            "fax_number": "302-990-3290"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9901 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Rockville",
            "state": "MD",
            "postal_code": "208503357",
            "country_code": "US",
            "telephone_number": "301-315-3171",
            "fax_number": "240-826-7040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-14",
        "last_updated": "2018-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C0003687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeanne Stone, SCH. PSYCHOLOGIST
• Mary Stratton-Bey, BACHELOR
• Tshnina Elena Street, LPCMH, NCC
• Alexander Stroup, OTR
• Jessica Jane Sullivan, LPCMH
• Richard Sullivan, MSPT
• Uganda Sumner
• Sussex Montessori Charter School
• Sussex Surgical PA
• Darius S Sypek, MD

• Surgical Physician Assistant in Seaford, DE
• Providers in Seaford, DE by specialty
• Surgical Physician Assistant in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2018; 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.