ICEL R SULLIVAN (ARNP) – Pediatric Nurse Practitioner, NPI 1770116436
Pediatric Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ICEL R SULLIVAN (ARNP)
1911 COOKS HILL RD
CENTRALIA, WA 985319073
Phone: (360) 736-6778
Type: Mailing
1911 Cooks Hill Rd
Centralia, WA 985319073
Phone: (360) 736-6778
Type: Location
550 GAGE BLVD STE 101
RICHLAND, WA 993529532
Phone: (971) 358-2390
Fax: (509) 627-2983
Type: Mailing
888 SWIFT BLVD
RICHLAND, WA 993523514
Phone: (509) 946-4611
Type: Location
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 $143.
Total Amount is formed as General ($143) + Research ($0) + Ownership ($0) = $143.
Last reported payment date: 2023-08-21 • Largest payer in this snapshot: Abbott Laboratories ($143).
Total Amount
$143
General + Research + Ownership
Payments
1
Total payment records
General Amount
$143
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-08-21
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Abbott Laboratories | $143 |
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: 2021-11-16
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 |
|---|---|---|---|---|
| I20211116000795 | I | Nurse Practitioner | WA | 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 98531)
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