Sean Sullivan

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

OS022205 Issued in PA

Practice address

130 S Bryn Mawr Ave RM 471
Bryn Mawr, PA 19010-3121

Phone

(484) 337-4097

NPI assigned

Jun 28, 2019

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

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Main Line Healthcare

  • Family Medicine Physician
  • Newtown Square, PA
  • NPI 1922077643

  Internal Medicine

  Medicare reassignment NPD
• Main Line Hospitals, Inc.

  • General Acute Care Hospital
  • Bryn Mawr, PA
  • NPI 1508971441
  NPD (past)

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1043872138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3803 W CHESTER PIKE STE 160",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190732336",
            "telephone_number": "484-337-1530",
            "fax_number": "484-337-1412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 S BRYN MAWR AVE RM 471",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103121",
            "telephone_number": "484-337-4097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5501 Old York Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191413098",
            "country_code": "US",
            "telephone_number": "215-456-6013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SEAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-28",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS022205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Sudjian
• Sherry M Sukol, PHD
• Anna F Sullivan, MS
• Lauren Sullivan, LPC, MED, MS
• Nancy Sullivan, NBC-HWC
• Richard Fredric Summers, MD
• Summit Grove Counseling, LLC
• Summit Grove Therapy
• Megan Supp, ATC, CMT
• Aita Kai Susi, MD

• Internal Medicine Physician in Bryn Mawr, PA
• Providers in Bryn Mawr, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.