Active NPI
Paul Sullivan
- Physical Therapist
- Kailua Kona, HI
National Provider Identifier
1093884199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 2206
- Practice address
- 75-5699 Kopiko St
Kailua Kona, HI 96740-1668 - Phone
- (808) 329-7744
- NPI assigned
- Nov 6, 2006
- Last updated
- Feb 14, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 2206 | HI | Primary |
Addresses
Primary practice location
75-5699 Kopiko St
Kailua Kona, HI 96740-1668
Mailing address
75-5699 Kopiko St
Kailua Kona, HI 96740-1668
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A013 | Other | HI | TRICARE |
| 0000244996 | Other | HI | HMSA/BC-BS |
| 576639-01 | Medicaid | HI | |
| 244996 | Other | HI | HMSA 65C |
| 8457294 | Other | HI | UHA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 2206 | HI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202947200000",
"number": "1093884199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75-5699 KOPIKO ST",
"city": "KAILUA KONA",
"state": "HI",
"postal_code": "967401668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75-5699 KOPIKO ST",
"city": "KAILUA KONA",
"state": "HI",
"postal_code": "967401668",
"telephone_number": "808-329-7744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "PAUL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-06",
"last_updated": "2008-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "HI",
"license": "PT 2206",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "A013",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMSA/BC-BS",
"identifier": "0000244996",
"state": "HI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "576639-01",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMSA 65C",
"identifier": "244996",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHA",
"identifier": "8457294",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kailua Kona, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.