Jacqueline Rose Sullivan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

520 W Fayette St Ste 300
Baltimore, MD 21201-1756

Phone

(724) 422-2261

NPI assigned

Sep 18, 2023

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 MD

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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Practices of Antietam, LLCGroup PAC ID 2567353865, 229 clinicians

Meritus Medical Center IncGroup PAC ID 7113811795, 730 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Meritus Medical Center Hospital, Hagerstown, MD, CCN 210001

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Medical Practices of Antietam LLC

  • Clinic/Center
  • Hagerstown, MD
  • NPI 1710854963
  Medicare reassignment Care Compare group NPD
• Meritus Medical Center Inc

  • Nurse Practitioner
  • Hagerstown, MD
  • NPI 1205176393
  Medicare reassignment Care Compare group
• Medical Practices of Antietam LLC

  • Sports Medicine (Internal Medicine) Physician
  • Hagerstown, MD
  • NPI 1184481459
  NPD
• Meritus Medical Center Inc

  • Diagnostic Radiology Physician
  • Hagerstown, MD
  • NPI 1184477911
  NPD
• Meritus Medical Center Inc

  • Emergency Medicine Physician
  • Hagerstown, MD
  • NPI 1396980405
  NPD

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

• Meritus Medical Center Inc

  • General Acute Care Hospital
  • Hagerstown, MD
  • NPI 1942281266
  Care Compare affiliation

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

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1740068253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36525 KIDWELL RD",
            "city": "HILLSBORO",
            "state": "VA",
            "postal_code": "201321701",
            "telephone_number": "724-422-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 W FAYETTE ST STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011756",
            "telephone_number": "724-422-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JACQUELINE",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-18",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cari Rose Sullivan, PT
• Catherine Atchison Sullivan, PSYD
• David Sullivan, M.D.
• Eleanor Margaret Sullivan
• Holly Lynn Sullivan, CCC-SP
• Jada Sullivan
• Jessica Page Sullivan, CRNP-PMH
• Kammie Lynnette Sullivan, OTR/L
• Kathleen D Sullivan, LCPC
• Kelsey Sullivan

• Physician Assistant in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; 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.