SUSAN M SULLIVAN (FNP) – Adult Health Nurse Practitioner, NPI 1679900757

SUSAN M SULLIVAN (FNP) is a healthcare provider. based in Ballwin, Missouri. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP. They hold a License No. 2013039392 (MO). The NPI Number for SUSAN M SULLIVAN (FNP) is 1679900757

Main info

Female
13 Years Of Experience
Accepts Medicare Assignment
Name
SUSAN M SULLIVAN (FNP)
NPI
1679900757
Phone
(636) 256-5000
Address
15945 CLAYTON RD STE 120A
Enumeration Date
3 October 2013
Last Update Date
10 February 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6362405454
Graduation Year
2013 (13 years ago)
PAC ID
9133358260
Group Practice PAC ID
3072421254
Professional Enrollment ID
I20140212000578
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience48
Completeness85
Years active:12State licenses:1Digital endpointsOther names

7,017 NURSE PRACTITIONER in MO

Provider Addresses for SUSAN M SULLIVAN (FNP)

  • 15945 CLAYTON RD STE 120A

    BALLWIN, MO 630112490

    Phone: (636) 256-5000

    Fax: (636) 256-5043

    Type: Mailing

  • 621 S NEW BALLAS RD STE 228A

    SAINT LOUIS, MO 631418256

    Phone: (314) 251-4966

    Fax: (314) 251-4588

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 4 Open Payments records for all available years, with a total value of $84.

Total Amount is formed as General ($84) + Research ($0) + Ownership ($0) = $84.

Last reported payment date: 2024-10-17 • Largest payer in this snapshot: Bayer Healthcare Pharmaceuticals Inc. ($39).

Total Amount

$84

General + Research + Ownership

Payments

4

Total payment records

General Amount

$84

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-17

Latest reported date

Top Companies

Largest payers in this snapshot

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: 2014-02-12

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
I20140212000578INurse PractitionerMOTBD

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes226196$0
99203New patient office or other outpatient visit, 30-44 minutes6969$0
View full utilization report →

Insurance plans in this area (ZIP 63011)

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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: 3072421254View full group profile
NameSpecialtyState
-MO
-MO
Family PracticeMO
Hospitalist, Family PracticeMO
Internal MedicineMO
-MO
Family PracticeMO
Internal MedicineIL
Internal Medicine, HospitalistMO
Nurse PractitionerMO

Reviews

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Frequently asked questions

What is the registry number for SUSAN M SULLIVAN (FNP)?
The registry entry for SUSAN M SULLIVAN (FNP) shows NPI 1679900757.
Is SUSAN M SULLIVAN (FNP) currently accepting referrals based on NPI status?
Registry metadata lists SUSAN M SULLIVAN (FNP) as active.
What type of care does SUSAN M SULLIVAN (FNP) provide?
SUSAN M SULLIVAN (FNP)'s profile centers on Adult Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Is SUSAN M SULLIVAN (FNP) tied to Ballwin, Missouri?
If you are local to Ballwin, Missouri, SUSAN M SULLIVAN (FNP) may be relevant to your search.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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