NPIMap

Individual provider Active NPI

Ryan A Sullivan, MD

  • Internal Medicine Physician
  • Manistee, MI
National Provider Identifier
1174605653
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
430308010 Issued in MI
Practice address
2198 US Highway 31 S
Manistee, MI 49660-9618
Phone
(231) 723-3567
NPI assigned
Oct 20, 2006
Last updated
Dec 30, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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 430308010 MI Primary

Addresses

Primary practice location

2198 US Highway 31 S
Manistee, MI 49660-9618

Mailing address

6227 Frankfort Hwy
Benzonia, MI 49616-8632
Phone (231) 882-9661

Other identifiers 3

IdentifierTypeStateIssuer
P00267590OtherMIRAILROAD MEDICARE
1105115182OtherMIBCBS
4764828MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ryansullivan@clhcmi.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20050906000090 MI Practitioner - Internal Medicine 0547292294 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Crystal Lake Clinic PCGroup PAC ID 0648259010, 14 clinicians

Practice addresses (Care Compare)

2198 US Hwy 31 S
Manistee, MI 49660-9618
Phone (231) 723-3567

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions19
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
430308010MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Crystal Lake Clinic PC Current Accepting new patients
Crystal Lake Clinic P.C. CurrentSince Sep 8, 2015 Accepting new patients
Crystal Lake Clinic, P.C. CurrentSince Sep 8, 2015 Accepting new patients
Munson Healthcare Manistee Hospital CurrentSince Jun 25, 2014 Accepting new patients
Paul Oliver Memorial Hospital CurrentSince Aug 1, 2015 Accepting new patients
Paul Oliver Memorial Hospital CurrentSince Aug 1, 2015 Accepting new patients
Munson Healthcare Manistee Hospital CurrentSince Jun 25, 2014 Accepting new patients
Manistee County Medical Care Past Accepting new patients
Crystal Lake Clinic, PC Past Accepting new patients
Crystal Lake Clinic P.C. Past Accepting new patients
Crystal Lake Clinic, P.C. Past Accepting new patients

Locations

6227 Frankfort Hwy
Benzonia, MI 49616
Phone (231) 882-9661

124 Ames St
Elk Rapids, MI 49629
Phone (231) 264-8282

224 Park Ave
Frankfort, MI 49635
Phone (231) 352-2200

1975 Stirling Dr
Interlochen, MI 49643
Phone (231) 275-0166

2283 E M 113
Kingsley, MI 49649
Phone (231) 263-0700

1293 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1735

1391 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1760

1391 E Parkdale Ave
Ste 103
Manistee, MI 49660
Phone (231) 398-1850

1465 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1000

2198 US Highway 31 S
Manistee, MI 49660
Phone (231) 655-3146

93 W Fourth St
Ste B
Suttons Bay, MI 49682
Phone (231) 271-5990

4025 Chums Village Dr
Traverse City, MI 49685
Phone (231) 642-5560

Interoperability endpoints

  • Direct secure messaging: ryansullivan@clhcmi.allscriptsdirect.net

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
Manistee County Medical CareManistee, MI, CCN 235003 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Mar 16, 2018
Feb 18, 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 11

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 10

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": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1174605653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6227 FRANKFORT HWY",
            "city": "BENZONIA",
            "state": "MI",
            "postal_code": "496168632",
            "telephone_number": "231-882-9661",
            "fax_number": "231-882-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2198 US HIGHWAY 31 S",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496609618",
            "telephone_number": "231-723-3567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "RYAN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "430308010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00267590",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1105115182",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4764828",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ryansullivan@clhcmi.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "2198 US HIGHWAY 31 S",
            "city": "MANISTEE",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496609618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Manistee, MI

Sources for this page

Verify at the official NPI Registry.