Stayce K Sullivan

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

95012073 Issued in CA

Practice address

515 Northgate Dr.
Ste. 101
San Rafael, CA 94903-9490

Phone

(415) 202-9990

Fax

(415) 202-0102

NPI assigned

Aug 12, 2019

Last updated

Aug 12, 2019By the provider in NPPES

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 CA

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Omar Osman Practice, LLCGroup PAC ID 4385014042, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Omar Osman Practice, LLC

  dba Comprehensive Rehab Consultants PC

  • Physical Medicine & Rehabilitation Physician
  • Morton Grove, IL
  • NPI 1669192472

  CA

  Medicare reassignment Care Compare group NPD
• Post Acute Rehabilitation Physicians LLC

  • Physical Medicine & Rehabilitation Physician
  • Lehi, UT
  • NPI 1023781028

  CA

  Medicare reassignment NPD
• Hampton Health LTD

  • Geriatric Medicine (Family Medicine) Physician
  • San Francisco, CA
  • NPI 1013142280
  NPD (past)

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

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1770139123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 GRANDE PASEO",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031546",
            "telephone_number": "509-995-7310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 NORTHGATE DR.",
            "address_2": "STE. 101",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949039490",
            "telephone_number": "415-202-9990",
            "fax_number": "415-202-0102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "STAYCE",
        "middle_name": "K",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-12",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95012073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonnie H. Sudler, MD
• Diane A. Suffridge, PH.D.
• Diana H. Suh, MD
• David J. Sulciner, MD
• Peter Vaughn Sullivan
• Summit Sober Living Inc.
• Sally Saemee Sun
• Lady Margie Sunico
• Sunrise II
• Renee Noemie Surcouf, LCSW

• Acute Care Nurse Practitioner in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Acute Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.