Emily Bennett Sullivan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-02197 Issued in NC

Practice address

1614 NC Highway 56
Creedmore, NC 27522-1688

Phone

(336) 552-5961

NPI assigned

Feb 22, 2010

Last updated

Mar 3, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Brody School of Medicine at East Carolina University, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Granville Health SystemGroup PAC ID 1052223757, 78 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Granville Health System

  dba Granville CRNA Group

  • Certified Registered Nurse Anesthetist
  • Oxford, NC
  • NPI 1275638512
  Medicare reassignment Care Compare group
• DRX High Point, PLLC

  dba American Family Care

  • Multi-Specialty Clinic/Center
  • High Point, NC
  • NPI 1669701306
  Medicare reassignment
• Zack Hall, MD PLLC

  • Internal Medicine Physician
  • Reidsville, NC
  • NPI 1003075219
  Medicare reassignment
• Granville Health System

  • Diagnostic Radiology Physician
  • Oxford, NC
  • NPI 1104683341
  NPD
• Granville Health System

  dba South Granville Primary Care

  • Rural Health Clinic/Center
  • Creedmoor, NC
  • NPI 1265430854
  NPD
• DRX High Point, PLLC

  dba American Family Care

  • Family Medicine Physician
  • High Point, NC
  • NPI 1164882031
  NPD (past)

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

{
    "created_epoch": "1266796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488499200000",
    "number": "1881916583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 KING ST",
            "address_2": "APT 2L",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274061688",
            "telephone_number": "336-552-5961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 NC HIGHWAY 56",
            "city": "CREEDMORE",
            "state": "NC",
            "postal_code": "275221688",
            "telephone_number": "336-552-5961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "EMILY",
        "middle_name": "BENNETT",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-22",
        "last_updated": "2017-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-02197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2017; 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.