NPIMap

Individual provider Active NPI

Kelly Ingrid Sullivan, MD

  • Pediatrics Physician
  • College Station, TX
National Provider Identifier
1043492291
Registry record updated May 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
N1166 Issued in TX
Practice address
1602 Rock Prairie Rd
Suite 340
College Station, TX 77845-8306
Phone
(979) 696-4440
Fax
(979) 696-7812
NPI assigned
Nov 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X N1166 TX Primary

Addresses

Primary practice location

1602 Rock Prairie Rd
Suite 340
College Station, TX 77845-8306

Mailing address

1602 Rock Prairie Rd
Suite 340
College Station, TX 77845-8306
Phone (979) 696-4440

Other names 1

  • Kelly Ingrid Machen Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
N1166TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
TCH Pediatric Associates, Inc Pediatrics Past Accepting new patients
TCH Pediatric Associates, Inc Pediatrics Past Accepting new patients
University Pediatric Association Pediatrics Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274400000000",
    "number": "1043492291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 ROCK PRAIRIE RD",
            "address_2": "SUITE 340",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458306",
            "telephone_number": "979-696-4440",
            "fax_number": "979-696-7812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 ROCK PRAIRIE RD",
            "address_2": "SUITE 340",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458306",
            "telephone_number": "979-696-4440",
            "fax_number": "979-696-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KELLY",
        "middle_name": "INGRID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-29",
        "last_updated": "2010-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "N1166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "MACHEN",
            "middle_name": "INGRID",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in College Station, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.