Alyse Marie Sullivan, NP is a medicare enrolled "Clinical Nurse Specialist - Women's Health" in Antioch, Tennessee. Her current practice location is
950 Brittany Park Dr Apt 423, Antioch, Tennessee. You can reach out to her office (for appointments etc.) via phone at
(530) 848-2648.
Alyse Marie Sullivan is licensed to practice in North Carolina (license number SULL-MEKDS) 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 1811777105.
Provider's Profile
| Full Name | Alyse Marie Sullivan |
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| Gender | Female |
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| Speciality | Clinical Nurse Specialist - Women's Health |
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| Location | 950 Brittany Park Dr Apt 423, Antioch, Tennessee |
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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: 1811777105
- Provider Enumeration Date: 10/03/2023
- Last Update Date: 10/03/2023
Medicare PECOS Information:
- PECOS PAC ID: 2961841911
- Enrollment ID: I20240423004033
Medical Identifiers
Medical identifiers for Alyse Marie Sullivan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1811777105 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 364SW0102X | Clinical Nurse Specialist - Women's Health | SULL-MEKDS (North Carolina) | 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. Alyse Marie Sullivan allows following entities to bill medicare on her behalf.
| Entity Name | Community Medicine Foundation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1528004918
PECOS PAC ID: 4880687490
Enrollment ID: O20040407001159 |
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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. Alyse Marie 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 |
|---|
Alyse Marie Sullivan, NP
950 Brittany Park Dr Apt 423,
Antioch, TN 37013-5065
Ph: (530) 848-2648 | Alyse Marie Sullivan, NP
950 Brittany Park Dr Apt 423,
Antioch, TN 37013-5065
Ph: (530) 848-2648 |
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