Individual provider Active NPI

Jill Paula Sullivan-Keating, NP

  • Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1851413983
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5013058 Issued in NC
Practice address
3030 Randolph Rd
Ste 200
Charlotte, NC 28211-1368
Phone
(704) 302-8555
NPI assigned
Apr 6, 2007
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5013058 NC Primary
Adult Health Nurse Practitioner 363LA2200X 5013058 NC

Addresses

Primary practice location

3030 Randolph Rd
Ste 200
Charlotte, NC 28211-1368

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

447 McAlister Rd
Ste 2400
Lincolnton, NC 28092-4114
Phone (704) 302-8555

Other practice location 2

10650 Park Rd
Ste 330
Charlotte, NC 28210-8538
Phone (704) 302-8555

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jsullivankeating454136@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20081204000411 NY Practitioner - Nurse Practitioner 5597826958 Reassigns benefits to 1 organization
I20200521000951 NC Practitioner - Nurse Practitioner 5597826958 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Carolinas Physicians Network IncGroup PAC ID 3375449655, 2,324 clinicians

Practice addresses (Care Compare)

3030 Randolph Rd
Suite 200
Charlotte, NC 28211-1365
Phone (704) 302-8555

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5013058NCMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Peter's Hospitalof the City of Albany CurrentSince May 21, 2012 Accepting new patients
Carolinas Physicians Network Inc CurrentSince May 18, 2020 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
St. Peter's Hospital of the City of Albany Nurse Practitioner CurrentSince May 21, 2012 Accepting new patients
St. Peter's Hospital of the City of Albany Nurse Practitioner Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince May 18, 2020 Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

10650 Park Rd
Ste 330
Charlotte, NC 28210
Phone (704) 468-8877

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070

3030 Randolph Rd
Ste 200
Charlotte, NC 28211
Phone (704) 302-8200

447 McAlister Rd
Ste 2400
Lincolnton, NC 28092
Phone (980) 212-6500

315 S Manning Blvd
Albany, NY 12208
Phone (518) 525-1852

Interoperability endpoints

  • Direct secure messaging: jsullivankeating454136@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 6

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": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1851413983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 RANDOLPH RD",
            "address_2": "STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111368",
            "telephone_number": "704-302-8555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "447 McAlister Rd",
            "address_2": "Ste 2400",
            "address_purpose": "LOCATION",
            "city": "Lincolnton",
            "state": "NC",
            "postal_code": "280924114",
            "country_code": "US",
            "telephone_number": "704-302-8555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10650 Park Rd",
            "address_2": "Ste 330",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108538",
            "country_code": "US",
            "telephone_number": "704-302-8555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN-KEATING",
        "first_name": "JILL",
        "middle_name": "PAULA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-06",
        "last_updated": "2024-07-15",
        "certification_date": "2020-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5013058",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "5013058",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsullivankeating454136@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "3030 Randolph Rd",
            "address_2": "Ste 200",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282111368",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.