Justin Micheal Sullivan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00553600 Issued in NJ

Practice address

205 E Laurel Rd
Stratford, NJ 08084-1301

Phone

(856) 344-2315

NPI assigned

Nov 20, 2019

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 NJ

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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kennedy Medical Group Practice, P.C.Group PAC ID 2860616877, 417 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Kennedy Medical Group Practice, P.C.

  • Family Medicine Physician
  • Voorhees, NJ
  • NPI 1952726796
  Medicare reassignment Care Compare group
• Kennedy Medical Group P.C.

  • Psychologist
  • Voorhees, NJ
  • NPI 1609314004
  NPD
• Kennedy Medical Group Practice PC

  • Family Medicine Physician
  • Sewell, NJ
  • NPI 1952848905
  NPD
• Kennedy Medical Group Practice P.C.

  • Family Medicine Physician
  • West Deptford, NJ
  • NPI 1952615981
  NPD (past)
• Southern Jersey Family Medical Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Hammonton, NJ
  • NPI 1568473973
  NPD (past)

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

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581379200000",
    "number": "1821634239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 E LAUREL RD",
            "city": "STRATFORD",
            "state": "NJ",
            "postal_code": "080841301",
            "telephone_number": "844-542-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E LAUREL RD",
            "city": "STRATFORD",
            "state": "NJ",
            "postal_code": "080841301",
            "telephone_number": "856-344-2315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JUSTIN",
        "middle_name": "MICHEAL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-20",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00553600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0714275",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stratford Board of Education
• Stratford Center for Spinal Health, LLC
• Stratford Nursing and Convalescent Center, Inc.
• Marianne Sturr, D.O.
• Huda Sufian, R.PH
• Allen F Summerville Sr., LSW
• Surgical Nurse Assistant
• Monika Melissa Szeliga, DO
• Maria Szpiech, M.D.
• Shaun R Tamashausky, DO

• Physician Assistant in Stratford, NJ
• Providers in Stratford, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; 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.