Timothy John Sullivan III, M.D.

Primary specialty

Allergy PhysicianTaxonomy code 207KA0200X

License

8263858-1205 Issued in UT

Practice address

4403 Harrison Blvd.
Ste 4640
Ogden, UT 84403-3304

Phone

(801) 387-4850

Fax

(801) 387-4855

NPI assigned

Jun 8, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Allergy/Immunology

Education

University of Miami, LM Miller School of Medicine, 1966

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vicki J Lyons MD PCGroup PAC ID 4486558566, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health McKay-Dee Hospital Hospital, Ogden, UT, CCN 460004

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: timothy.sullivan.advancedallergyasthma@aaa.direct.systemedx.com

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.

• Vicki J Lyons MD PC

  • Allergy Physician
  • Ogden, UT
  • NPI 1780716563
  Medicare reassignment Care Compare group NPD
• Atlanta ENT Sinus & Allergy Associates PC

  • Specialist
  • Atlanta, GA
  • NPI 1285619544
  NPD (past)

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

• Ihc Health Services Inc

  dba Intermountain Health McKay-Dee Hospital

  • General Acute Care Hospital
  • Ogden, UT
  • NPI 1194749580
  Care Compare affiliation

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433289600000",
    "number": "1023012911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4403 HARRISON BLVD.",
            "address_2": "STE 4640",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033304",
            "telephone_number": "801-387-4850",
            "fax_number": "801-387-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 HARRISON BLVD.",
            "address_2": "STE 4640",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844033304",
            "telephone_number": "801-387-4850",
            "fax_number": "801-387-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2015-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "GA",
            "license": "037913",
            "primary": false
        },
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "UT",
            "license": "8263858-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00570996C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00570996F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sawyer Sudweeks
• Trent Suggs, M.D.
• Inger Alice Camille Sullenger, RN
• Lauren Sullivan
• Melody L Sullivan
• Clarke Summers, MD
• Sundance Physical Therapy LLC
• Susan C Hustad MD, PC
• Forrest Sutherland
• Nykole Sutherland, MS; LCGC

• Allergy Physician in Ogden, UT
• Providers in Ogden, UT by specialty
• Allergy Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.