NPIMap

Individual provider Active NPI

Michael E Sullivan, M.D.

  • Family Medicine Physician
  • Watertown, WI
National Provider Identifier
1093883142
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
46656 Issued in WI
Practice address
127 Hospital Dr
Watertown, WI 53098-3303
Phone
(920) 261-8500
NPI assigned
Nov 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 46656 WI Primary

Addresses

Primary practice location

127 Hospital Dr
Watertown, WI 53098-3303

Mailing address

127 Hospital Dr
Watertown, WI 53098-3303
Phone (920) 261-8500

Other identifiers 1

IdentifierTypeStateIssuer
34560600MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20040701000385 WI Practitioner - Family Practice 1153308887 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Watertown Family Practice Associates, SCGroup PAC ID 4183608037, 10 clinicians
Oak Medical SCGroup PAC ID 0042595175, 118 clinicians

Practice addresses (Care Compare)

127 Hospital Dr
Watertown, WI 53098-3303
Phone (920) 261-8500

7500 W Dean Rd
Milwaukee, WI 53223-2638
Phone (414) 371-7300

Hospital & facility affiliations

  • Commonheart Home Health Home health agency, Waukesha, WI, CCN 527151
  • Commonheart Hospice Hospice, Waukesha, WI, CCN 521578
  • Watertown Memorial Hospital Hospital, Watertown, WI, CCN 520116
  • Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008
  • Fort Memorial Hospital Hospital, Fort Atkinson, WI, CCN 520071
  • Marquardt Memorial Manor Nursing home, Watertown, WI, CCN 525543

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions17
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46656WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Medical SC CurrentSince Jan 1, 2020 Accepting new patients
Watertown Family Practice Associates S.C. Family Medicine CurrentSince Aug 9, 2004 Accepting new patients
Memorial Hospital of South Bend Past Accepting new patients

Locations

127 Hospital Dr
Watertown, WI 53098
Phone (414) 261-8500

N20W22961 Watertown Rd
Waukesha, WI 53186
Phone (262) 875-5070

2428 N Grandview Blvd
Ste 102
Waukesha, WI 53188
Phone (262) 875-5070

Interoperability endpoints

  • Direct secure messaging: michael.sullivan.1@20962.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/20962/brand/1/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Marquardt Memorial Manor, Inc.Watertown, WI, CCN 525543 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 1, 2012
Aug 25, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Hospital & facility affiliations 7

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": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649289600000",
    "number": "1093883142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 HOSPITAL DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983303",
            "telephone_number": "920-261-8500",
            "fax_number": "920-261-8828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 HOSPITAL DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983303",
            "telephone_number": "920-261-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MICHAEL",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "46656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34560600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, WI

Sources for this page

Verify at the official NPI Registry.