NPIMap

Individual provider Active NPI

William J Sullivan, D.O.

  • Internal Medicine Physician
  • Frontenac, KS
National Provider Identifier
1093805897
Registry record updated Aug 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
05-25406 Issued in KS
Practice address
608 Willard
Frontenac, KS 66763-2120
Phone
(620) 231-8849
Fax
(620) 231-8847
NPI assigned
Oct 13, 2006
Last updated
Aug 6, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 05-25406 KS Primary

Addresses

Primary practice location

608 Willard
Frontenac, KS 66763-2120

Mailing address

PO Box 1023
Frontenac, KS 66763-1023
Phone (620) 231-8849

Other identifiers 9

IdentifierTypeStateIssuer
100234810DMedicaidKS
110994OtherKSGROUP BCBS
DA9115OtherKSGRP RR MEDICARE
P00077657OtherKSRR MEDICARE
103449OtherKSBCBS
103449OtherKSMEDICARE
189381OtherKSCOVENTRY
110994OtherKSMEDICARE
200213791OtherKSTRICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040122000434 KS Practitioner - Internal Medicine 1759282080 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ability KCGroup PAC ID 0143116368, 166 clinicians
Freeman-Oak Hill Health SystemGroup PAC ID 8325942253, 385 clinicians

Practice addresses (Care Compare)

3011 Baltimore Ave
Kansas City, MO 64108-3403
Phone (816) 751-7832

608 Willard St
Frontenac, KS 66763-2120
Phone (620) 231-8849

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.37 of 100Reported as group
Quality
60.15
Promoting interoperability
100
Improvement activities
40
Cost
77.74

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Melanoma (skin cancer) excision1-10
Removal of skin lesions74
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
05-25406KSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Medical Laboratory, Inc Current Accepting new patients
Pathology Laboratory Associates, Inc. Current Accepting new patients
Freeman-Oak Hill Health System Past Accepting new patients
Mercy Clinic Pittsburg LLC Internal Medicine Past Accepting new patients

Locations

1 Mt Carmel Way
Pittsburg, KS 66762
Phone (620) 231-6100

2401 S Tucker Ave
Ste 1
Pittsburg, KS 66762
Phone (620) 231-1650

Organizations & group practices 7

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470441600000",
    "number": "1093805897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1023",
            "city": "FRONTENAC",
            "state": "KS",
            "postal_code": "667631023",
            "telephone_number": "620-231-8849",
            "fax_number": "620-231-8847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 WILLARD",
            "city": "FRONTENAC",
            "state": "KS",
            "postal_code": "667632120",
            "telephone_number": "620-231-8849",
            "fax_number": "620-231-8847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "WILLIAM",
        "middle_name": "J",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2016-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "05-25406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100234810D",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BCBS",
            "identifier": "110994",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GRP RR MEDICARE",
            "identifier": "DA9115",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00077657",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "103449",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "103449",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY",
            "identifier": "189381",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "110994",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "200213791",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frontenac, KS

Sources for this page

Verify at the official NPI Registry.