Jennifer Diane Sullivan, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

2021-03325 Issued in NC

Practice address

1000 Blythe Blvd
Charlotte, NC 28203-5812

Phone

(704) 355-2171

NPI assigned

Jun 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IN, NC2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jsullivan691172@carolinashealthcaresystem.direct-ci.com

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Carolinas Medical Center at Home LLC

  • Home Health Agency
  • Lincolnton, NC
  • NPI 1326223892

  Corporate Director, Corporate Officer

  CMS ownership
• Carolinas Medical Center at Home, LLC

  • Home Health Agency
  • Shelby, NC
  • NPI 1144222365

  Corporate Director, Corporate Officer

  CMS ownership
• Carolinas Medical Center at Home, LLC

  • Home Health Agency
  • Morganton, NC
  • NPI 1154495158

  Corporate Director, Corporate Officer

  CMS ownership
• Carolinas Medical Center at Home, LLC

  • Home Health Agency
  • Monroe, NC
  • NPI 1215568746

  Corporate Director, Corporate Officer

  CMS ownership
• Carolinas Medical Center at Home, LLC

  • Home Health Agency
  • Charlotte, NC
  • NPI 1336186220

  Corporate Director, Corporate Officer

  CMS ownership
• Carolinas Medical Center at Home, LLC

  • Home Health Agency
  • Albemarle, NC
  • NPI 1417320318

  Corporate Director, Corporate Officer

  CMS ownership
• Carolinas Medical Center at Home, LLC

  • Home Health Agency
  • Charlotte, NC
  • NPI 1780046110

  Corporate Director, Corporate Officer

  CMS ownership
• Carolinas Palliative Care and Hospice Network, Inc.

  • Community Based Hospice Care Agency
  • Monroe, NC
  • NPI 1538255997

  Corporate Director, Corporate Officer

  CMS ownership
• Hospice of Cabarrus County Inc.

  • Community Based Hospice Care Agency
  • Kannapolis, NC
  • NPI 1700830700

  Corporate Director, Corporate Officer

  CMS ownership
• Carolinas Medical Center at Home, LLC

  • Home Health Agency
  • Rock Hill, SC
  • NPI 1912447996

  Corporate Director, Corporate Officer

  CMS ownership

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.

• Carolinas Medical Center

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1275774333

  Pediatrics

  Medicare reassignment NPD
• Indiana University Health Care Associates, Inc

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1902032832
  Medicare reassignment NPD
• Carolinas Medical Center

  • Surgical Critical Care Physician
  • Charlotte, NC
  • NPI 1699979732

  Emergency Medicine

  NPD
• Carolinas Medical Center

  • Community/Retail Pharmacy
  • Charlotte, NC
  • NPI 1982710554
  NPD
• Indiana University Psychiatric Associates, Inc.

  • Psychiatry Physician
  • Indianapolis, IN
  • NPI 1023063724
  NPD
• Carolinas Medical Center at Home LLC

  • Durable Medical Equipment & Medical Supplies
  • Winston Salem, NC
  • NPI 1184596744
  NPD (past)
• Emergency Medical Group, Inc.

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1073570529
  NPD (past)
• Emgi - Riley, LLC

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1720020381
  NPD (past)
• Emgi - University, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Indianapolis, IN
  • NPI 1508808783
  NPD (past)
• Icem-University-Riley, LLC

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1417284563
  NPD (past)
• University Medical Diagnostic Associates, Inc.

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1861441537
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1992748982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JENNIFER",
        "middle_name": "DIANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2024-07-15",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2021-03325",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2021-03325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsullivan691172@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "1000 Blythe Blvd",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282035812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Billy Lee Sullivan II, MD
• Bryan E. Sullivan, LPC
• Catherine M Sullivan, OTR/L
• Cynthia Marie Sullivan, RN
• David Matthew Sullivan, MD
• Jeremy Isaiah Sullivan, MD
• Jordan Patrick Sullivan
• Joseph Earle Sullivan, DDS
• Katherine Alleyn Sullivan
• Lauren Marie Sullivan, DO

• Emergency Medicine Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Emergency Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.