Individual provider Active NPI

John Patrick Sullivan, PA-C

  • Physician Assistant
  • Savannah, GA
National Provider Identifier
1720832041
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
709 Mall Blvd
Savannah, GA 31406-4805
Phone
(912) 201-8000
NPI assigned
Apr 15, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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 Primary

Addresses

Primary practice location

709 Mall Blvd
Savannah, GA 31406-4805

Mailing address

709 Mall Blvd
Savannah, GA 31406-4805
Phone (912) 201-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20241204002784 NC Practitioner - Physician Assistant 2264968049 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gastonia Physician Services, PLLC CurrentSince Sep 24, 2024 Accepting new patients
Gastonia Physician Services, PLLC CurrentSince Sep 24, 2024 Accepting new patients
Northern Cochise Community Hospital Inc PastSince Apr 21, 2024 Accepting new patients

Locations

5665 New Northside Dr
Ste 320
Sandy Springs, GA 30328
Phone (770) 874-5468

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1720832041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 MALL BLVD",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314064805",
            "telephone_number": "912-201-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 MALL BLVD",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314064805",
            "telephone_number": "912-201-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JOHN",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.