Matthew Sullivan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

9765 San Jose Blvd Ste 102
Jacksonville, FL 32257-5467

Phone

(904) 260-5757

Fax

(904) 268-0733

NPI assigned

Sep 2, 2021

Sex

Male

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 FL, GA2 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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ibrahim Heart Clinic PLLCGroup PAC ID 4688958648, 43 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/26160/brand/1/csg/1/fhir/r4

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.

• Ibrahim Heart Clinic PLLC

  • Clinical Cardiac Electrophysiology Physician
  • Jacksonville, FL
  • NPI 1629511035

  GA

  Medicare reassignment Care Compare group
• Luis F Anez MD PA

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1538347380
  Medicare reassignment
• River City Nephrology PLLC

  • Nephrology Physician
  • Jacksonville, FL
  • NPI 1093450652
  NPD (past)

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

{
    "created_epoch": "1630540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1952079915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3748 BOWDEN RD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166223",
            "telephone_number": "904-300-8044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9765 SAN JOSE BLVD STE 102",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322575467",
            "telephone_number": "904-260-5757",
            "fax_number": "904-268-0733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MATTHEW",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-02",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Michael Sullivan, D.M.D, M.S.
• John P Sullivan, MD
• Kara Sullivan, DPT
• Kimberly Sullivan, LMT
• Luz Yorlady Sullivan, MD
• Michael Kevin Sullivan
• Victor Sullivan Jr.
• Nicole Sultan
• Senan Sultan, M.D.
• Rachel Sultzer, CLC

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 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.