Individual provider Active NPI

Katie Marie Sullivan, NP

  • Nurse Practitioner
  • East Lansing, MI
National Provider Identifier
1801533864
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704327523 Issued in MI
Practice address
4650 S Hagadorn Rd Ste 100
East Lansing, MI 48823-5386
Phone
(517) 353-4830
Fax
(517) 355-2134
NPI assigned
May 19, 2022
Last updated
Nov 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4704327523 MI
Nurse Practitioner 363L00000X 4704327523 MI Primary

Addresses

Primary practice location

4650 S Hagadorn Rd Ste 100
East Lansing, MI 48823-5386

Mailing address

804 Service Rd Ste A202
East Lansing, MI 48824-7015

Other practice location 1

1540 Lake Lansing Rd Ste G6
Lansing, MI 48912-3757
Phone (517) 482-7246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20230103002347 MI Practitioner - Nurse Practitioner 9032589379 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Msu Health Care Inc.Group PAC ID 8628404936, 201 clinicians

Practice addresses (Care Compare)

4650 S Hagadorn Rd
Suite 100
East Lansing, MI 48823-5386
Phone (517) 353-4830

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704327523MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Msu Health Care Inc. CurrentSince Jan 1, 2024 Accepting new patients
Msu Health Care Inc Current Accepting new patients
Msu Health Care Inc CurrentSince Jan 1, 2024 Accepting new patients
Msu Health Care Inc. Past Accepting new patients

Locations

4650 S Hagadorn Rd
Ste 100
East Lansing, MI 48823
Phone (517) 353-4830

4660 S Hagadorn Rd
Ste 500
East Lansing, MI 48823
Phone (517) 432-6144

804 Service Rd
Ste A202
East Lansing, MI 48824
Phone (517) 884-2976

1215 E Michigan Ave
Lansing, MI 48912
Phone (517) 336-8080

Interoperability endpoints

  • Direct secure messaging: katie.sullivan.1@25394.direct.athenahealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1652918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1801533864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A202",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "fax_number": "517-432-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 S HAGADORN RD STE 100",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488235386",
            "telephone_number": "517-353-4830",
            "fax_number": "517-355-2134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1540 Lake Lansing Rd Ste G6",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489123757",
            "country_code": "US",
            "telephone_number": "517-482-7246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KATIE",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-19",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704327523",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704327523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Lansing, MI

Sources for this page

Verify at the official NPI Registry.