Tyler Matthew Sullivan, RN

Primary specialty

Adult Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0809X

License

RN2295420 Issued in MA

Practice address

14 Porter St
East Boston, MA 02128

Phone

(617) 569-3189

NPI assigned

Oct 3, 2019

Last updated

Oct 3, 2019By the provider in NPPES

Sex

Male

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 MA

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Newton-Wellesley PsychiatryGroup PAC ID 1759282304, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Newton-Wellesley Hospital Hospital, Newton, MA, CCN 220101

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sullivan.tyler.nwpmd@direct.partners.masshiway.net

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.

• Newton-Wellesley Psychiatry

  • Psychiatry Physician
  • Wellesley, MA
  • NPI 1427029297
  Medicare reassignment Care Compare group NPD
• North Suffolk Community Services Inc.

  • Clinic/Center
  • East Boston, MA
  • NPI 1740209881
  Medicare reassignment NPD

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

• Newton-Wellesley Hospital

  • General Acute Care Hospital
  • Newton, MA
  • NPI 1992737761
  Care Compare affiliation

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

{
    "created_epoch": "1570060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1750922449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 CEDAR ST",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024815513",
            "telephone_number": "978-912-1967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 PORTER ST",
            "city": "EAST BOSTON",
            "state": "MA",
            "postal_code": "02128",
            "telephone_number": "617-569-3189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "TYLER",
        "middle_name": "MATTHEW",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-03",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MA",
            "license": "RN2295420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Strauss
• Peter G Stringham, M.D.
• July Andrea Suarez Santos, LICSW
• Emily Faye Sullivan, MT-BC
• Shauna Kathleen Sullivan, CNP
• Michael F. Swinchoski, M.ED.
• Jessica Syswerda, CNP
• Swapna Rao Takkallapelli, CNP
• Yueyun Tang
• Ayeh Tanteh, CNP

• Adult Psychiatric/Mental Health Registered Nurse in East Boston, MA
• Providers in East Boston, MA by specialty
• Adult Psychiatric/Mental Health Registered Nurse in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; 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.