MRS. MARY ELLEN SULLIVAN GNP-BC
NPI 1861676942
Nurse Practitioner - Gerontology in Columbia, SC

NPI Status: Active since December 25, 2007

Contact Information

111 DOCTOR CIR
COLUMBIA, SC
ZIP 29203
Phone: (800) 491-0909

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Physician Visit Costs
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Years of Experience 19
Nurse Practitioner
Gerontology
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled
Medicare Quality Reporting

About MARY ELLEN SULLIVAN

This page provides the complete NPI Profile along with additional information for Mary Ellen Sullivan, a provider established in Columbia, South Carolina with a medical specialization in Nurse Practitioner, focusing in gerontology and more than 19 years of experience. The healthcare provider is registered in the NPI registry with number 1861676942 assigned on December 2007. The practitioner's primary taxonomy code is 363LG0600X with license number 3428 (SC). The provider is registered as an individual and her NPI record was last updated 4 years ago.

NPI: 1861676942
Provider Name: MRS. MARY ELLEN SULLIVAN GNP-BC
Gender: Female
Entity Type: Individual
Location Address: 111 DOCTOR CIR COLUMBIA, SC 29203
Location Phone: (800) 491-0909
Mailing Address: 111 DOCTOR CIR COLUMBIA, SC 29203
Mailing Phone: (800) 491-0909
Medical School Name: OTHER
Graduation Year: 2007
Is Sole Proprietor?: No
Enumeration Date: 12-25-2007
Last Update Date: 11-09-2022
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A nurse practitioner (NP) like Mary Ellen Sullivan is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Nurse Practitioner Gerontology
Taxonomy Code: 363LG0600X
Type: Physician Assistants & Advanced Practice Nursing Providers
License No.: 3428
License State: SC

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

BlueCross BlueShield of South Carolina

Blue Direction Bronze 1 - POS
Blue Direction Silver 1 - POS
Blue Direction Silver 1 + Adult Vision - POS
Blue Direction Silver 2 - POS
Blue Direction Standard Expanded Bronze - POS
Blue Direction Standard Gold - POS
Blue Direction Standard Silver - POS
Blue VirtuConnect Bronze 1 - EPO
Blue VirtuConnect Gold 1 - EPO
Blue VirtuConnect Silver 1 - EPO
BlueEssentials Bronze 4 - EPO
BlueEssentials Bronze 6 - EPO
BlueEssentials Gold 1 - EPO
BlueEssentials Gold 5 - EPO
BlueEssentials Silver 14 - EPO
BlueEssentials Silver 14 + Adult Vision - EPO
BlueEssentials Silver 40 - EPO
BlueEssentials Standard Expanded Bronze - EPO
BlueEssentials Standard Gold - EPO
BlueEssentials Standard Silver - EPO

Molina Healthcare

Molina Gold Core 1640 - HMO
Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO
Molina Gold Core 1640 Plus with Adult Vision - HMO
Molina Gold Standard - HMO
Molina Gold Value - HMO
Molina Gold Value Plus with Adult Dental and Vision - HMO
Molina Gold Value Plus with Adult Vision - HMO
Molina Silver Core - HMO
Molina Silver Core Plus with Adult Dental and Vision - HMO
Molina Silver Core Plus with Adult Vision - HMO
Molina Silver Saver - HMO
Molina Silver Standard - HMO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Mary Ellen Sullivan is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Mary Ellen Sullivan is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

Is the provider registered in PECOS? Yes
PECOS PAC ID: 3779651781
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.
PECOS Enrollment ID: I20081003000578
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.
Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Advance care planning, first 30 minutes
Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month
Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month
Complex chronic care management services for two or more chronic conditions, each additional 60 minutes of clinical staff time directed by health care professional, per calendar month
Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month
Established patient home visit, typically 25 minutes
Established patient home visit, typically 40 minutes
Extended patient service without direct patient contact, first hour
New patient home visit, typically 1 hour
New patient home visit, typically 45 minutes
Telephone medical discussion with physician, 11-20 minutes
Telephone medical discussion with physician, 21-30 minutes
Telephone medical discussion with physician, 5-10 minutes

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $20.79 for a new patient copayment and $23.78 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 29203 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

Average New Patient Price $83.18
Minimum New Patient Price $53.57
Maximum New Patient Price $163.84

Average New Patient Copayment $20.79
Minimum New Patient Copayment $13.39
Maximum New Patient Copayment $40.96

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

Average Established Patient Price $95.12
Minimum Established Patient Price $16.96
Maximum Established Patient Price $133.52

Average Established Patient Copayment $23.78
Minimum Established Patient Copayment $4.24
Maximum Established Patient Copayment $33.38

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure	Performance	Number of Patients
Care Plan	92%	90
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan
Chronic Care and Preventative Care Management for Empaneled Patients	Yes	N/A
Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation.
Colorectal Cancer Screening	3%	30
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Documentation of Current Medications in the Medical Record	99%	241
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
e-Prescribing	76%	442
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Implementation of medication management practice improvements	Yes	N/A
Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews.
Measurement and Improvement at the Practice and Panel Level	Yes	N/A
Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level.
Medication Reconciliation	75%	24
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education	89%	128
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Provide Patient Access	27%	128
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Security Risk Analysis	Yes	N/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Specialized Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI.
Use of decision support and standardized treatment protocols	Yes	N/A
Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1861676942, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 68. The final step is to find the difference between that total and the next multiple of ten (70 - 68 = 2).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 12 → 1 + 2

Pos 4

Unchanged

Pos 5

Doubled → 12 → 1 + 2

Pos 6

Unchanged

Pos 7

Doubled → 12 → 1 + 2

Pos 8

Unchanged

Pos 9

Doubled → 8

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 6 → 12 → 3 6 → 12 → 3 6 → 12 → 3 4 → 8

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 8 + 1 + 2 + 1 + 1 + 2 + 7 + 1 + 2 + 9 + 8 + 24 = 68

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 68 is 70. The difference is the calculated check digit.

70 - 68 = 2

This NPI is valid

The calculated check digit is 2, which matches the last digit of 1861676942.