Active NPI
John K Sullivan, DDS
- Dentist
- Springfield, OR
National Provider Identifier
1063564979
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(14) exclusion effective May 20, 2019.
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D10371
- Practice address
- 498 Harlow Rd
Suite 1
Springfield, OR 97477 - Phone
- (541) 225-4866
- Fax
- (888) 502-2518
- NPI assigned
- Jan 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D10371 | OR | Primary |
Addresses
Primary practice location
498 Harlow Rd
Suite 1
Springfield, OR 97477
Mailing address
498 Harlow Rd
Suite 1
Springfield, OR 97477
Phone (541) 225-4866
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10371 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458777600000",
"number": "1063564979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "498 HARLOW RD",
"address_2": "SUITE 1",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "97477",
"telephone_number": "541-225-4866",
"fax_number": "888-502-2518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "498 HARLOW RD",
"address_2": "SUITE 1",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "97477",
"telephone_number": "541-225-4866",
"fax_number": "888-502-2518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "JOHN",
"middle_name": "K",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2016-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D10371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.