CHARLES SULLIVAN (NPI# 1417193723) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417193723 |
| Entity Type | Individual |
| Full Name | CHARLES SULLIVAN |
| Credential | CMP |
| Practice Address |
132 Lower Ridge Rd Conway AR 72032-8518 |
| Mailing Address |
Po Box 1589 Benton AR 72018-1589 |
| Practice Telephone | 5015489905 |
| Mailing Telephone | 5013153344 |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2009-08-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | AR | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801190194 | Charles Robert Sullivan | Pharmacist | 230 E Johnson Ave, Coos Bay, OR 97420-1478 | 2010-12-31 |
| 1144433863 | Charles D Sullivan | Psychologist | 265 Route 46 West, Suite 202, Totowa, NJ 07512 | 2007-05-08 |
| 1003984311 | Charles W Sullivan | Neuromusculoskeletal Medicine & OMM | 98 Second St, Hallowell, ME 04347-1368 | 2006-12-04 |
| 1811086069 | Charles B Sullivan | Chiropractor | 4678 N 1st St, Fresno, CA 93726-0903 | 2006-10-12 |
| 1821562612 | Charles Blake Sullivan | Physical Therapist | 4645 Village Square Dr Ste A, Paducah, KY 42001-7448 | 2019-01-15 |
| 1033687215 | Charles Sullivan | Counselor | 6013 S Redwood Rd, Taylorsville, UT 84123-5220 | 2018-11-06 |
| 1114093259 | Charles Sullivan | Social Worker | 10 High St Ste 10, Medford, MA 02155-3848 | 2006-11-28 |
| 1033163381 | Charles D Sullivan | Family Medicine | 840 N 5th Ave, Ste 2100, Sequim, WA 98382-3045 | 2006-05-20 |
| 1619929635 | Charles L Sullivan | Orthopaedic Surgery | 2360 Mullan Rd, Suite C., Missoula, MT 59808-1811 | 2006-05-17 |
| 1801857693 | Charles David Sullivan | Pathology | 1 Lile Ct, Suite 101, Little Rock, AR 72205-6242 | 2006-03-31 |
| Street Address |
132 LOWER RIDGE RD |
| City | CONWAY |
| State | AR |
| Zip Code | 72032-8518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033163175 | Carol Marie Kretzmann | Counselor | 132 Lower Ridge Rd, Conway, AR 72032-8518 | 2006-05-22 |
| 1649880857 | Haley Squires | Case Manager/Care Coordinator | 132 Lower Ridge Rd, Conway, AR 72032-8518 | 2020-08-03 |
| 1811506405 | Jaden Johns | Case Manager/Care Coordinator | 132 Lower Ridge Rd, Conway, AR 72032-8518 | 2020-07-29 |
| 1306465604 | Angela Montrose | Registered Nurse | 132 Lower Ridge Rd, Conway, AR 72032-8518 | 2020-04-16 |
| 1518593250 | Cynthia Shuffield | Social Worker | 132 Lower Ridge Rd, Conway, AR 72032-8518 | 2020-03-13 |
| 1912546409 | James Hensley | Case Manager/Care Coordinator | 132 Lower Ridge Rd, Conway, AR 72032-8518 | 2019-12-31 |
| 1518514348 | Nannilena White | Case Manager/Care Coordinator | 132 Lower Ridge Rd, Conway, AR 72032-8518 | 2019-08-26 |
| 1114574571 | James Peer | Case Manager/Care Coordinator | 132 Lower Ridge Rd, Conway, AR 72032-8518 | 2019-08-21 |
| 1386291748 | Tiayana Davis | Case Manager/Care Coordinator | 132 Lower Ridge Rd, Conway, AR 72032-8518 | 2019-08-21 |
| 1043867393 | Jennifer Nelson | Case Manager/Care Coordinator | 132 Lower Ridge Rd, Conway, AR 72032-8518 | 2019-08-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730789843 | Amelia S Lasater | Pharmacist | 1155 Hwy 65n, Conway, AR 72032 | 2020-10-28 |
| 1619584604 | Danyelle Durocher | Occupational Therapist | 1301 North Museum Rd, Conway, AR 72032 | 2020-09-24 |
| 1780222174 | Eric Herman Boxnick | Pharmacist | 101 West Oak Street, Conway, AR 72032 | 2019-12-16 |
| 1932746070 | Habilitation Center, LLC | Psychiatric Residential Treatment Facility | 161 Skunk Hollow Road, Conway, AR 72032 | 2019-12-09 |
| 1679051668 | Mary Elizabeth Black | Nurse Practitioner | 222 Dave Ward Drive, Conway, AR 72032 | 2018-08-01 |
| 1275035602 | Conway Dental Center Pllc | Dentist | 1600 E. Oak Street Suite B, Conway, AR 72032 | 2018-03-01 |
| 1750821625 | Luke Osborne | Physical Therapy Assistant | 1 Thomas Ln, Conway, AR 72032 | 2017-02-27 |
| 1639620099 | Sam's West, Inc. | Technician/Technologist | 1250 South Amity Rd, Conway, AR 72032 | 2016-10-20 |
| 1922559343 | Sam's West, Inc. | Durable Medical Equipment & Medical Supplies | 1250 Sourth Amity Rd, Conway, AR 72032 | 2016-10-20 |
| 1639629108 | Posture Store | Durable Medical Equipment & Medical Supplies | 3900 Dave Ward Dr., Suite 1900-130, Conway, AR 72032 | 2016-10-09 |
| Find all providers in zip 72032 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013563758 | Shelby M Perez | Case Manager/Care Coordinator | 3240 Stermer Rd, Conway, AR 72034 | 2019-08-16 |
| 1508371865 | Ebony Latreace Charleston | Case Manager/Care Coordinator | 3240 Stermer Road, Conway, AR 72034 | 2017-12-08 |
| 1720516289 | Wendy A Magbanua | Case Manager/Care Coordinator | 317 Lower Ridge Rd, Conway, AR 72035-0001 | 2017-05-30 |
| 1538609417 | Eric Dillinger | Case Manager/Care Coordinator | 61 Winding Branch Ln, Conway, AR 72032-8701 | 2017-02-27 |
| 1023487097 | Comeatrieze Vantelia Ester | Case Manager/Care Coordinator | 816 N. Creek Dr., Conway, AR 72032 | 2015-09-21 |
| 1275938615 | Ian Evans | Case Manager/Care Coordinator | 818 N. Creek Dr., Conway, AR 72032 | 2014-10-28 |
| 1982007977 | Tina Boone | Case Manager/Care Coordinator | 816 N. Creek Dr, Conway, AR 72032 | 2014-10-03 |
| 1154738110 | Brittney Morgan Wood | Case Manager/Care Coordinator | 2175 B Rosemary Drive, Conway, AR 72034 | 2014-07-22 |
| 1063779437 | Sara Coleta Garland | Case Manager/Care Coordinator | 1100 Bob Courtway Dr # Dre, Suite 9, Conway, AR 72032-4766 | 2012-04-23 |
| 1427363209 | Careteam Plus, Inc. | Case Manager/Care Coordinator | 100 Professional Park Drive, Conway, SC 29526-9260 | 2010-08-17 |
| Find all providers in CONWAY | ||||
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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.