Active NPI
Linda Irene Mandic O Sullivan, DC
- Chiropractor
- Tillson, NY
National Provider Identifier
1962530014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- X004812
- Practice address
- 10 Spring St
Tillson, NY 12486 - Phone
- (845) 658-9345
- Fax
- (845) 339-2143
- NPI assigned
- Mar 1, 2007
- Last updated
- Sep 7, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | X004812 | NY | Primary |
Addresses
Primary practice location
10 Spring St
Tillson, NY 12486
Mailing address
10 Spring Street
Tillson, NY 12486
Phone (845) 658-9345
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120613000525 | NY | Practitioner - Chiropractic | 0749444248 | Practice locations: Kingston, NY; Tillson, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 1986
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
10 Spring St
Tillson, NY 12486-1217
Phone (845) 658-9345
240 Clinton Ave
Kingston, NY 12401-2909
Phone (845) 339-9300
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| X004812 | NY | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694044800000",
"number": "1962530014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 SPRING STREET",
"city": "TILLSON",
"state": "NY",
"postal_code": "12486",
"telephone_number": "845-658-9345",
"fax_number": "845-339-2143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 SPRING ST",
"city": "TILLSON",
"state": "NY",
"postal_code": "12486",
"telephone_number": "845-658-9345",
"fax_number": "845-339-2143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDIC O SULLIVAN",
"first_name": "LINDA",
"middle_name": "IRENE",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-01",
"last_updated": "2023-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NY",
"license": "X004812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tillson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.