Active NPI
Susan Bowles Sullivan, RDN, LD
- Registered Dietitian
- Lexington, SC
National Provider Identifier
1881184349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1595
- Practice address
- 147 Vera Rd Ste a
Lexington, SC 29072-3756 - Phone
- (803) 575-0468
- NPI assigned
- May 10, 2018
- Last updated
- Aug 7, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1595 | SC | Primary |
Addresses
Primary practice location
147 Vera Rd Ste a
Lexington, SC 29072-3756
Mailing address
407 W Main St
Lexington, SC 29072-2661
Phone (803) 996-0312
Other practice location 1
905 Pope St
Newberry, SC 29108-1928
Phone (803) 575-0468
Other practice location 2
446 Oak Grove Rd
Boone, NC 28607-7618
Phone (803) 575-0468
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Susan Sullivan Nutrition LLC | Dietitian, Registered | Current | Accepting new patients |
| Path of Life Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Path of Life Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Registered Dietitian
- Lexington, SC
- NPI 1235863424
Dietitian, Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691366400000",
"number": "1881184349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "407 W MAIN ST",
"city": "LEXINGTON",
"state": "SC",
"postal_code": "290722661",
"telephone_number": "803-996-0312",
"fax_number": "803-957-2496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "147 VERA RD STE A",
"city": "LEXINGTON",
"state": "SC",
"postal_code": "290723756",
"telephone_number": "803-575-0468"
}
],
"practiceLocations": [
{
"address_1": "905 Pope St",
"address_purpose": "LOCATION",
"city": "Newberry",
"state": "SC",
"postal_code": "291081928",
"country_code": "US",
"telephone_number": "803-575-0468",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "446 Oak Grove Rd",
"address_purpose": "LOCATION",
"city": "Boone",
"state": "NC",
"postal_code": "286077618",
"country_code": "US",
"telephone_number": "803-575-0468",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SULLIVAN",
"first_name": "SUSAN",
"middle_name": "BOWLES",
"credential": "RDN, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-10",
"last_updated": "2023-08-07",
"certification_date": "2023-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "SC",
"license": "1595",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.