Misha Sullivan, PA-C, ATC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0845 Issued in NH

Practice address

185 Queen City Ave
Manchester, NH 03101-7121

Phone

(603) 625-1655

Fax

(603) 626-4686

NPI assigned

Feb 27, 2007

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 NH

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elliot Professional ServicesGroup PAC ID 6103727920, 429 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elliot Hospital Hospital, Manchester, NH, CCN 300012

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.

• Elliot Professional Services

  • Internal Medicine Physician
  • Manchester, NH
  • NPI 1285627935
  Medicare reassignment Care Compare group

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

• Elliot Hospital of the City of Manchester

  • General Acute Care Hospital
  • Manchester, NH
  • NPI 1902996028
  Care Compare affiliation

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317340800000",
    "number": "1760519698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 QUEEN CITY AVE",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031017121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 QUEEN CITY AVE",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031017121",
            "telephone_number": "603-625-1655",
            "fax_number": "603-626-4686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MISHA",
        "name_prefix": "Mrs.",
        "credential": "PA-C, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2011-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "0845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Edward Sudati, D.M.D.
• Daniel J Sullivan, RPH
• Gabrielle Sullivan, MSW
• Kayleigh Ann Sullivan, PA-C
• Lindsay Sullivan, RN
• Noreen Sullivan, RN
• Tina Sullivan, RN
• William Kevin Sullivan, DMD
• Allison Lou Summers, PA-C
• Jocelyn Summers

• Physician Assistant in Manchester, NH
• Providers in Manchester, NH by specialty
• Physician Assistant in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; 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.