Mary A Sullivan, PCNS is a medicare enrolled "Nurse Practitioner - Gerontology" provider in Providence, Rhode Island. Her current practice location is
50 Maude St, Providence, Rhode Island. You can reach out to her office (for appointments etc.) via phone at
(401) 456-2000.
Mary A Sullivan is licensed to practice in California (license number 21544) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1386662484.
Healthcare Provider's Profile
| Full Name | Mary A Sullivan |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Gerontology |
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| Location | 50 Maude St, Providence, Rhode Island |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1386662484
- Provider Enumeration Date: 07/17/2006
- Last Update Date: 02/02/2012
Medicare PECOS Information:
- PECOS PAC ID: 8729094131
- Enrollment ID: I20120320000963
Medical Identifiers
Medical identifiers for Mary A Sullivan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1386662484 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | PPNS00073 (Rhode Island) | Secondary |
| 363LG0600X | Nurse Practitioner - Gerontology | 21544 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mary A Sullivan allows following entities to bill medicare on her behalf.
| Entity Name | Telecare Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1720164882
PECOS PAC ID: 6901820380
Enrollment ID: O20070614000167 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mary A Sullivan is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mary A Sullivan, PCNS
50 Maude St,
Providence, RI 02908-4325
Ph: (401) 456-2000 | Mary A Sullivan, PCNS
50 Maude St,
Providence, RI 02908-4325
Ph: (401) 456-2000 |
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