MS. STEPHANIE M. SULLIVAN (MSN, NP) – Obstetrics & Gynecology Nurse Practitioner, NPI 1730121864

MS. STEPHANIE M. SULLIVAN (MSN, NP) is a healthcare provider. based in Berkeley, California. specializing in NURSE PRACTITIONER. They hold the professional credentials MSN, NP. They hold a License No. 566514 (CA). The NPI Number for MS. STEPHANIE M. SULLIVAN (MSN, NP) is 1730121864

Main info

Female
26 Years Of Experience
Accepts Medicare Assignment
Name
MS. STEPHANIE M. SULLIVAN (MSN, NP)
NPI
1730121864
Phone
(510) 204-5770
Address
2001 DWIGHT WAY
Enumeration Date
12 June 2006
Last Update Date
11 January 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5107521000
Graduation Year
2000 (26 years ago)
PAC ID
4082641220
Group Practice PAC ID
8921910225
Professional Enrollment ID
I20050720000253
Address ID
CA946115613OA3701XBROA200
Telehealth
Yes

Contacts

SOAP Endpoint
https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness85
Years active:20State licenses:1Other namesUpdated within 12 months

16,360 NURSE PRACTITIONER in CA

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Provider Addresses for MS. STEPHANIE M. SULLIVAN (MSN, NP)

  • Sutter Urgent Care - Berkeley, 2001, Dwight Way, Downtown Berkeley, Berkeley, Alameda County, California, 94704, United States

    SECOND FLOOR

    BERKELEY, CA 947042608

    Phone: (510) 204-5770

    Fax: (510) 204-5749

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $23.

Total Amount is formed as General ($23) + Research ($0) + Ownership ($0) = $23.

Last reported payment date: 2024-05-01 • Largest payer in this snapshot: TerSera Therapeutics LLC ($23).

Total Amount

$23

General + Research + Ownership

Payments

1

Total payment records

General Amount

$23

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-05-01

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
TerSera Therapeutics LLC$23
View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2005-07-20

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20050720000253INurse PractitionerCATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 94704)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8921910225View full group profile
NameSpecialtyState
Emergency MedicineDC
Colorectal Surgery (Proctology), General SurgeryLA
-CA
N E U R O S U R G E R YMA
Internal MedicineCA
Nurse PractitionerCA
Internal MedicineCA
Emergency MedicineCA
-MA
Emergency MedicineCA

Reviews

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Frequently asked questions

What NPI should I save for MS. STEPHANIE M. SULLIVAN (MSN, NP)?
Save NPI 1730121864 if you need a stable reference for MS. STEPHANIE M. SULLIVAN (MSN, NP).
Is MS. STEPHANIE M. SULLIVAN (MSN, NP) active in the national directory?
MS. STEPHANIE M. SULLIVAN (MSN, NP)'s public NPI profile is in an active state.
Does MS. STEPHANIE M. SULLIVAN (MSN, NP) list a primary specialty?
If you are matching referrals, note Obstetrics & Gynecology Nurse Practitioner for MS. STEPHANIE M. SULLIVAN (MSN, NP). Clinical services aligned with this taxonomy classification.
Where is MS. STEPHANIE M. SULLIVAN (MSN, NP)'s primary listing?
We display Berkeley, California because that is what the record indicates for MS. STEPHANIE M. SULLIVAN (MSN, NP).
What if Berkeley, California seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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