Jordan Sullenberger

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4704292266 Issued in MI

Practice address

900 Peeler St
Kalamazoo, MI 49008-2300

Phone

(269) 345-8618

Fax

(269) 345-1508

NPI assigned

Nov 23, 2016

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kalamazoo Anesthesiology P CGroup PAC ID 3375449473, 135 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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.

• Kalamazoo Anesthesiology P C

  • Anesthesiology Physician
  • Kalamazoo, MI
  • NPI 1407821796
  Medicare reassignment Care Compare group NPD

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

• Bronson Methodist Hospital

  • General Acute Care Hospital
  • Kalamazoo, MI
  • NPI 1831116441
  Care Compare affiliation

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

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484179200000",
    "number": "1760925713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 PEELER ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490082300",
            "telephone_number": "269-345-8618",
            "fax_number": "269-345-1508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 PEELER ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490082300",
            "telephone_number": "269-345-8618",
            "fax_number": "269-345-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLENBERGER",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-23",
        "last_updated": "2017-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704292266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI LICENSE",
            "identifier": "4704292266",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sue E Ryder LLC
• Kelsey Suggs, MD
• Fnu Suha Tarannum, MD
• Suji Home LLC
• Shuaib Sulaiman
• Alexander William Sullivan, MSW
• Corbin Draper Sullivan, M.D.
• Jacqueline Sullivan
• Katherine Sullivan
• Kathryn Ann Sullivan

• Certified Registered Nurse Anesthetist in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Certified Registered Nurse Anesthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.