Scot A Sullivan, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD21723 Issued in OR

Practice address

10305 SW Park Way Ste 203
Portland, OR 97225-5033

Phone

(503) 223-8333

Fax

(503) 595-8160

NPI assigned

Mar 18, 2006

Last updated

Sep 17, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

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.

Enrollment records 1

Specialty

Ophthalmology

Education

University of Oklahoma College of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St Vincent Medical Center Hospital, Portland, OR, CCN 380004

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Portland Oculoplastics, PC

  • Ophthalmology Physician
  • Portland, OR
  • NPI 1316121692
  Medicare reassignment NPD Authorized official
• Scot a Sullivan MD PC

  • Medical Specialty Clinic/Center
  • Edmond, OK
  • NPI 1831610641
  NPD Authorized official
• Dean McGee Eye Institute

  • Ophthalmology Physician
  • Oklahoma City, OK
  • NPI 1245209675
  NPD (past)

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

• Providence Health & Services - Oregon

  dba Providence St Vincent Medical Center

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1114015971
  Care Compare affiliation

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

{
    "created_epoch": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1164481230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10305 SW PARK WAY STE 203",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255033",
            "telephone_number": "503-223-8333",
            "fax_number": "503-595-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10305 SW PARK WAY STE 203",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255033",
            "telephone_number": "503-223-8333",
            "fax_number": "503-595-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SCOT",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-18",
        "last_updated": "2021-09-17",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OK",
            "license": "20157",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OR",
            "license": "MD21723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PIN",
            "identifier": "134409",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100102160B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter Damian Sullivan, MD
• Richard John Sullivan, LMT
• Rosemary Sullivan
• Ryan Sullivan
• Ryan Joseph Sullivan
• Serena D Sullivan
• Stephen Sullivan
• Tessandrea Sullivan
• Bariisaa Kedir Sultan
• Gary L Sultany, MD

• Ophthalmology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Ophthalmology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.