MR. JERRY L. SULLIVAN JR. (NPI# 1306909551) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306909551 |
| Entity Type | Individual |
| Full Name | MR. JERRY L. SULLIVAN JR. |
| Credential | ATC |
| Practice Address |
3631 S. Sixth Street Springfield IL 62703 |
| Mailing Address |
706 E Ash St Taylorville IL 62568-1657 |
| Practice Telephone | 2173414955 |
| Mailing Telephone | 2178242863 |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457409807 | Jerry Sullivan | Nurse Practitioner | 120 Market Street, Woodland, MS 39776 | 2007-01-08 |
| 1083697742 | Jerry L Sullivan | Dentist | 1007 Reelfoot Ave, Union City, TN 38261 | 2005-11-26 |
| 1093929044 | Jerry L Sullivan | Dentist | 411 Grandview Ave, Kingman, AZ 86401-5745 | 2007-05-09 |
| 1306998406 | Jerry J. Sullivan | Family Medicine | 6501 Loisdale Ct, Springfield, VA 22150-1826 | 2007-01-17 |
| 1689697641 | Jerry Warner Sullivan | Internal Medicine | 301 N Jefferson Davis Pkwy, 1st Floor, New Orleans, LA 70119-5311 | 2006-07-25 |
| 1487631594 | Jerry Sullivan | Physical Therapist | 1975 Lin Lor Ln, Elgin, IL 60123-4902 | 2005-12-29 |
| 1629062724 | Jerry Sullivan | Physician Assistant | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2005-09-02 |
| Street Address |
3631 S. SIXTH STREET |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790260917 | Jessica Lynne Zeeck | Behavior Technician | 5220 6th Street Frontage Road, E Suite 1700, Springfield, IL 62703 | 2018-10-03 |
| 1215415799 | Bree Schmulbach | Nurse Practitioner | Bsb Room 20, Springfield, IL 62703 | 2018-08-06 |
| 1144712100 | Fresenius Medical Care Springfield East, LLC | Clinic/Center | 140 S. Martin Luther King Jr. Drive, Springfield, IL 62703 | 2018-06-05 |
| 1558889170 | Ji Woung Choi | Dentist | 687 E Linton Ave., Springfield, IL 62703 | 2017-09-04 |
| 1477006161 | Encompass Home Health of The Midwest,llc | Home Health | 2970 Baker Dr, Springfield, IL 62703 | 2016-07-28 |
| 1851706824 | Terah Louise Holland | Obstetrics & Gynecology | 1100 E Lincolnshire Blvd Ste 200, Springfield, IL 62703 | 2014-06-27 |
| 1578993101 | Corey Moore | Behavioral Analyst | 5520 South 6th Street Road, Suite 1700, Springfield, IL 62703 | 2013-11-18 |
| 1134463052 | The Center for Youth and Family Solutions Inc. | Voluntary or Charitable | 614 North Sixth Street, Springfield, IL 62703 | 2012-11-15 |
| 1447519111 | Tenshi Furumi | Specialist/Technologist | One University Plaza, Univ. of Illinois-springfield, Ms Rec 2004, Springfield, IL 62703 | 2012-05-15 |
| 1447558390 | Shalini Mulkanoor | Family Medicine | 1100 E. Lincolnshire Blvd., Suite 200, Springfield, IL 62703 | 2011-03-02 |
| Find all providers in zip 62703 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467051516 | Kangjun Lee | Specialist/Technologist | 901 S. National Ave., Springfield, MO 65897 | 2020-10-20 |
| 1740806413 | Megan Herter | Specialist/Technologist | 1513 Old Ivy Dr, Springfield, IL 62711-8156 | 2020-06-18 |
| 1124649702 | Bridget Fenger | Specialist/Technologist | 521 W Central St, Springfield, MN 56087-1213 | 2020-05-05 |
| 1598302846 | Tamanna Kazi | Specialist/Technologist | 6746 Metropolitan Center Dr Apt 204, Springfield, VA 22150-4582 | 2019-12-05 |
| 1861035172 | Kory Matthew Kasper | Specialist/Technologist | 117 N Pittsburg Lndg, Springfield, IL 62711-8208 | 2019-10-21 |
| 1760037691 | Lauren Potter | Specialist/Technologist | 607 Highland Rd, Springfield, VT 05156-8844 | 2019-08-07 |
| 1033763271 | Ariana Nicole Hetland-purna | Specialist/Technologist | 1045 Grand St (art Annex Building), Springfield, MO 65897-0001 | 2019-07-25 |
| 1962968867 | Chad Michael Linck | Specialist/Technologist | 2125 N Glenstone Ave, Springfield, MO 65802 | 2019-02-15 |
| 1669938080 | Corey Michael Ratsch | Specialist/Technologist | 1116 E Cherry St Rm 300, Springfield, MO 65807-1517 | 2019-02-11 |
| 1164987640 | Emilee Pierce | Specialist/Technologist | 2015 W University St Apt E212, Springfield, MO 65807-7890 | 2019-02-08 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62703 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.