Mark Sullivan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004099 Issued in NY

Practice address

1 Tallow Wood Dr
Clifton Park, NY 12065-2807

Phone

(518) 373-4444

Fax

(518) 373-0663

NPI assigned

May 4, 2006

Last updated

Dec 7, 2015By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• St. Peter's Health Partners Medical Associates, P.C.

  • Multi-Specialty Clinic/Center
  • Albany, NY
  • NPI 1750626834

  Physician Assistant

  Medicare reassignment NPD
• Samaritan Hospital of Troy, New York

  • General Acute Care Hospital
  • Troy, NY
  • NPI 1043267727
  Medicare reassignment
• Island Medical Empire State, PLLC

  • Emergency Medicine Physician
  • Oneonta, NY
  • NPI 1053623041

  Physician Assistant

  NPD (past)
• Pegasus Emergency Medicine Troy Ny PC

  • Emergency Medicine Physician
  • Troy, NY
  • NPI 1255361531
  NPD (past)

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449446400000",
    "number": "1821046921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 PALISADES DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122051449",
            "telephone_number": "518-591-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 TALLOW WOOD DR",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120652807",
            "telephone_number": "518-373-4444",
            "fax_number": "518-373-0663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MARK",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2015-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "004099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02347280",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sherman S Stovall Jr., LCSW-R, MA
• Strength Therapy LCSW PLLC
• Erin Kathryn Student, NP
• Sunitha Sukumaran, MD
• Amy Iris Sullivan, PMHNP
• Namassivaya Sumithra, B.D.S.
• Chang Sook Sung, DDS
• Jin Sung, DMD
• Shannon Sweeney, MS, CCC-SLP
• Anne Marie Swota, RN

• Physician Assistant in Clifton Park, NY
• Providers in Clifton Park, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.