Active NPI
Robert Kelly O'Sullivan, PA-C
- Medical Physician Assistant
- Goldsboro, NC
National Provider Identifier
1841358058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 0010-02243
- Practice address
- Cherry Hospital
1401 West Ash Street
Goldsboro, NC 27530-1078 - Phone
- (919) 947-8252
- Fax
- (919) 705-5140
- NPI assigned
- Dec 4, 2006
- Last updated
- Nov 4, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0010-02243 | NC | Primary |
Addresses
Primary practice location
Cherry Hospital
1401 West Ash Street
Goldsboro, NC 27530-1078
Mailing address
Cherry Hospital
1401 West Ash Street
Goldsboro, NC 27530-1078
Phone (919) 947-8252
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151217002599 | NC | Order and Referring Only - Physician Assistant | 5395937502 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-02243 | NC | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604448000000",
"number": "1841358058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "CHERRY HOSPITAL",
"address_2": "1401 WEST ASH STREET",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275301078",
"telephone_number": "919-947-8252",
"fax_number": "919-705-5140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CHERRY HOSPITAL",
"address_2": "1401 WEST ASH STREET",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275301078",
"telephone_number": "919-947-8252",
"fax_number": "919-705-5140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'SULLIVAN",
"first_name": "ROBERT",
"middle_name": "KELLY",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2020-11-04",
"certification_date": "2020-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NC",
"license": "0010-02243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goldsboro, NC
- O.R. Stovall DDS
- O'Berry Neuro Medical Treatment Center
- O'Berry Neuro-Medical Treatment Center
- O'Berry Neuro-Medical Treatment Center
- Chrystie O'Neal, MS.PSY CADC-R
- Constance Jeanette Oates, MSW, LCSW-A
- Virginia M Oates
- Oberry Center (Oberry Center Pharmacy)
- Oberry Neuro-Medical Treatment Center
- Oberry Neuro-Medical Treatment Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.