Jay Frederick Sullivan, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

169461 Issued in NY

Practice address

4882B North Jefferson Street
Pulaski, NY 13142

Phone

(315) 298-2768

Fax

(315) 298-2846

NPI assigned

Jul 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 13

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pulaski Medical Urgent Care PCGroup PAC ID 1951608579, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Oswego Health Home Care, LLC Home health agency, Fulton, NY, CCN 337284
• Hospice of Central New York Hospice, Liverpool, NY, CCN 331511
• Oswego Hospital Hospital, Oswego, NY, CCN 330218
• Samaritan Medical Center Hospital, Watertown, NY, CCN 330157
• University Hospital S U N Y Health Science Center Hospital, Syracuse, NY, CCN 330241
• St Joseph's Hospital Health Center Hospital, Syracuse, NY, CCN 330140

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Pulaski Medical Urgent Care, P.C

  dba Pulaski Urgent Care

  • Family Medicine Physician
  • Pulaski, NY
  • NPI 1568829356
  Medicare reassignment Care Compare group NPD Authorized official
• Jay F Sullivan MD PC

  • Family Medicine Physician
  • Pulaski, NY
  • NPI 1427189638
  Medicare reassignment NPD Authorized official

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

• Oswego Health Home Care LLC..

  • Home Health Agency
  • Fulton, NY
  • NPI 1285639625
  Care Compare affiliation
• Oswego Hospital

  • General Acute Care Hospital
  • Oswego, NY
  • NPI 1871678458
  Care Compare affiliation
• Samaritan Medical Center

  • General Acute Care Hospital
  • Watertown, NY
  • NPI 1598713745
  Care Compare affiliation
• St Josephs Hospital Health Center

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1508815333
  Care Compare affiliation
• Suny Health Science Center at Syracuse

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1578554630
  Care Compare affiliation
• The Caring Coalition of Central New York

  dba Hospice of Central New York

  • Community Based Hospice Care Agency
  • Liverpool, NY
  • NPI 1912098666
  Care Compare affiliation

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1861426413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4882B NORTH JEFFERSON STREET",
            "city": "PULASKI",
            "state": "NY",
            "postal_code": "13142",
            "telephone_number": "315-298-2768",
            "fax_number": "315-298-2846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4882B NORTH JEFFERSON STREET",
            "city": "PULASKI",
            "state": "NY",
            "postal_code": "13142",
            "telephone_number": "315-298-2768",
            "fax_number": "315-298-2846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JAY",
        "middle_name": "FREDERICK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "169461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RMSCO",
            "identifier": "000006298",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKER'S COMPENSATION",
            "identifier": "169461-1W",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "5900753",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01538238",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CC6514",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "799222",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "POMCO",
            "identifier": "161577435",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON HMO",
            "identifier": "5939163",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000006298",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "080155488",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "138562",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00020708301",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "691259",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julianne Rene Shelton, OD
• Smile Factory Inc
• Rachael Stahl
• Raymond Edward Stark, RN
• Aubryn Stelmashuck, FNP
• Marissa L Taber, RDH
• Samantha Taber
• Glenn F Thibault, MD
• Thomas Patrick McCue IV DDS PC (McCue Dntal)
• Linda Kuhns Troia, PA, LCSW

• Family Medicine Physician in Pulaski, NY
• Providers in Pulaski, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; 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.