JERRY SULLIVAN (P.A.) – Medical Physician Assistant, NPI 1629062724
Medical Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
4,430 PHYSICIAN ASSISTANT in GA
Provider Addresses for JERRY SULLIVAN (P.A.)
907 18TH ST E STE 400
TIFTON, GA 317943684
Phone: (229) 391-4100
Type: Mailing
2225 US HIGHWAY 41 N
TIFTON, GA 317942749
Phone: (229) 391-4100
Type: Location
907, 18th Street East, Tifton, Tift County, Georgia, 31794, United States
SUITE 150
TIFTON, GA 317943643
Phone: (229) 391-4100
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 84 Open Payments records for all available years, with a total value of $1,437.
Total Amount is formed as General ($1,437) + Research ($0) + Ownership ($0) = $1,437.
Last reported payment date: 2024-12-23 • Largest payer in this snapshot: ABBVIE INC. ($408).
Total Amount
$1,437
General + Research + Ownership
Payments
84
Total payment records
General Amount
$1,437
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $408 |
| IRONWOOD PHARMACEUTICALS, INC | $211 |
| Ardelyx, Inc. | $119 |
| Evoke Pharma, Inc. | $72 |
| Takeda Pharmaceuticals U.S.A., Inc. | $70 |
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: 2004-07-16
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040716000648 | I | Physician Assistant | GA | TBD |
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.
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 31794)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | GA | |
| Nurse Practitioner | GA | |
| - | GA | |
| Nurse Practitioner | GA | |
| - | GA | |
| - | GA | |
| Nurse Practitioner | GA | |
| Family Practice, Emergency Medicine | GA | |
| Internal Medicine, Critical Care (Intensivists), Pulmonary Disease, Pulmonary Disease | MD | |
| - | GA |
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