NPIMap

Individual provider Active NPI

Bruce F Sullens, PA-C

  • Physician Assistant
  • Chelsea, MI
National Provider Identifier
1003990300
Registry record updated Mar 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601003720 Issued in MI
Practice address
14700 East Old US 12
Chelsea, MI 48118-1185
Phone
(734) 475-1321
NPI assigned
Oct 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601003720 MI Primary
Medical Physician Assistant 363AM0700X 5601003720 MI

Addresses

Primary practice location

14700 East Old US 12
Chelsea, MI 48118-1185

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040416000739 MI Practitioner - Physician Assistant 3577558881 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

14700 E Old US Hwy 12
Chelsea, MI 48118-1185
Phone (734) 936-4000

1801 Briarwood Cir
Ann Arbor, MI 48108-3347
Phone (734) 539-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601003720MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wa Foote Memorial Hospital, Inc Physician Assistant CurrentSince Apr 12, 2010 Accepting new patients
W.a. Foote Memorial Hospital, Inc Physician Assistant CurrentSince Apr 12, 2010 Accepting new patients
Regents of the University of Michigan Physician Assistant CurrentSince Mar 31, 2011 Accepting new patients
Regents of the University of Michigan CurrentSince Mar 31, 2011 Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

3621 S State St
#700
Ann Arbor, MI 48108

1801 Briarwood Cir
Ann Arbor, MI 48108
Phone (734) 539-5000

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

14700 E Old US Highway 12
Chelsea, MI 48118
Phone (734) 475-1321

3235 E Michigan Ave
Jackson, MI 49202
Phone (517) 787-3280

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

Interoperability endpoints

  • Direct secure messaging: bsullens28188@direct.med.umich.edu

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301011200000",
    "number": "1003990300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14700 EAST OLD US 12",
            "city": "CHELSEA",
            "state": "MI",
            "postal_code": "481181185",
            "telephone_number": "734-475-1321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLENS",
        "first_name": "BRUCE",
        "middle_name": "F",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2011-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003720",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601003720",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chelsea, MI

Sources for this page

Verify at the official NPI Registry.