Scott Keith Sullivan Jr., MD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

MD.021287 Issued in LA

Practice address

1717 Saint Charles Ave
New Orleans, LA 70130-5223

Phone

(504) 899-2800

NPI assigned

Jul 25, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2019 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: sksullivan@directaddress.net
• Direct secure messaging: ssullivan@directaddress.net

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.

• Southern Surgical Specialists, LLC

  • Surgery Physician
  • Marrero, LA
  • NPI 1245235274
  NPD (past)
• St. Charles Surgical Hospital, LLC

  • Special Hospital
  • New Orleans, LA
  • NPI 1639323595
  NPD (past)
• Plastic, Reconstructive & Microsurgical Associates of South Texas PLLC

  • Plastic and Reconstructive Surgery Physician
  • San Antonio, TX
  • NPI 1063405504
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452124800000",
    "number": "1154344000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8664",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700118664",
            "telephone_number": "504-899-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 SAINT CHARLES AVE",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701305223",
            "telephone_number": "504-899-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SCOTT",
        "middle_name": "KEITH",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2016-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "LA",
            "license": "MD.021287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "192322",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frances Grace Sullivan
• Jerry Warner Sullivan, MD
• Kathleen Therese Sullivan, MD
• Kevin Michael Sullivan, MD
• Laura Sullivan, LPC, NCC
• Victoria Karryn Sullivan, DDS
• Ashley W Sulzer, CRNA
• Fnu Suman, M.D.
• Vanessa Sumler
• Warren Summer, MD

• Plastic and Reconstructive Surgery Physician in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Plastic and Reconstructive Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.