William Bruns Sullivan

Primary specialty

SpecialistTaxonomy code 174400000X

License

12999 Issued in MS

Practice address

109 Millsaps Dr
Suite C
Hattiesburg, MS 39402-1348

Phone

(601) 268-5051

Fax

(601) 268-5054

NPI assigned

May 2, 2006

Last updated

May 8, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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/ImmunologyAlso: Pediatric Medicine

Education

University of Alabama School of Medicine, 1987

Medicare assignment

May accept Medicare assignment

Group practices

Mississippi Asthma and Allergy Clinic PAGroup PAC ID 7416993522, 14 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

80.53 of 100Reported as group

Quality

61.06

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Mississippi Asthma & Allergy Clinic PA

  • Allergy & Immunology Physician
  • Jackson, MS
  • NPI 1902882251
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367971200000",
    "number": "1033177894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 MILLSAPS DR",
            "address_2": "SUITE C",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021587",
            "telephone_number": "601-268-5051",
            "fax_number": "601-268-5054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 MILLSAPS DR",
            "address_2": "SUITE C",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021348",
            "telephone_number": "601-268-5051",
            "fax_number": "601-268-5054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "WILLIAM",
        "middle_name": "BRUNS",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2013-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "12999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00118398",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vickie Leann Stuart, CRNA
• Kayla Suber
• Shawanda Suber, MD
• Traci Davis Suber, WHNP
• Loretta Sullivan, IDD WAIVER SERVICES
• Sunbelt Rehabilitation Systems, LLC (Sunbelt Rehab)
• Ellen M Sundberg, PH.D.
• Aimee Sundeen, M.D.
• Kimberly A.H. Sundland, CRNA
• Sunrise Healthcare LLC

• Specialist in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; 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.