Mari Catherine Sullivan, DNP, MSN, ARNP-C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

AP30001946 Issued in WA

Practice address

Port Gamble S'Klallam Tribe Community Health
32020 Little Boston Rd NE
Kingston, WA 98346

Phone

(360) 297-2840

Fax

(360) 925-3897

NPI assigned

Dec 5, 2006

Last updated

Aug 23, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Mari Catherine Sullivan Professional name

Medicare fee-for-service enrollment

Enrolled in WA

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, 2029

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Port Gamble S'Klallam TribeGroup PAC ID 6204737927, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mari.sullivan.p1@direct.pgsklallamtribe.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Port Gamble S'Klallam Tribe

  dba Port Gamble S'Klallam Health Center

  • Federally Qualified Health Center (FQHC)
  • Kingston, WA
  • NPI 1760428650
  Medicare reassignment Care Compare group NPD
• Port Gamble S'Klallam Tribe

  dba Tribal Medicaid FQHC

  • Federally Qualified Health Center (FQHC)
  • Kingston, WA
  • NPI 1518585579
  NPD

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1750449344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32020 LITTLE BOSTON RD NE",
            "city": "KINGSTON",
            "state": "WA",
            "postal_code": "983469734",
            "telephone_number": "360-297-2840",
            "fax_number": "360-925-3897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PORT GAMBLE S'KLALLAM TRIBE COMMUNITY HEALTH",
            "address_2": "32020 LITTLE BOSTON RD NE",
            "city": "KINGSTON",
            "state": "WA",
            "postal_code": "98346",
            "telephone_number": "360-297-2840",
            "fax_number": "360-925-3897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MARI",
        "middle_name": "CATHERINE",
        "name_prefix": "Dr.",
        "credential": "DNP, MSN, ARNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP300001946",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "AP30001946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARI",
            "last_name": "SULLIVAN",
            "middle_name": "CATHERINE",
            "prefix": "DR.",
            "credential": "DNP, MSN, ARNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Rachel Smart, LMH
• Mimi Sue Smith-Danielson, ARNP
• Peggy Sue Snow, LMP
• Elizabeth Annie Strandberg, MA61137883
• Emily Ann Stuart, LMP
• Tammy L Sullivan, CHR
• Chester Andrew Swanson, D.C.
• Mina Michel Ishak Tadros, RPH
• Daniel J Thacker, D.D.S,P.S.
• Marquita R Thompson, RC

• Family Medicine Physician in Kingston, WA
• Providers in Kingston, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; 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.