Kevin Brian Sullivan, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

20A18937 Issued in CA

Practice address

34800 Bob Wilson Dr
San Diego, CA 92134-1098

Phone

(970) 640-5914

NPI assigned

Jun 26, 2017

Last updated

Aug 6, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Emergency Medicine

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cep America - CaliforniaGroup PAC ID 6103739131, 1,278 clinicians

Emergency Services Medical Corporation CoronadoGroup PAC ID 3779904438, 26 clinicians

Team Physicians of Southern California Medical Group IncGroup PAC ID 0446545354, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pioneers Memorial Healthcare District Hospital, Brawley, CA, CCN 050342
• Sharp Coronado Hospital and Hlthcr Ctr Hospital, Coronado, CA, CCN 050234

Merit-based Incentive Payment System (MIPS)

Final score

96.69 of 100Reported as group

Quality

90

Improvement activities

40

Cost

78.43

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ksullivan158241@scrippshlth.medalliesdirect.net

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.

• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Santa Ana, CA
  • NPI 1548667843
  Medicare reassignment Care Compare group NPD
• Team Physicians of Southern California Medical Group, Inc.

  • Emergency Medicine Physician
  • Oceanside, CA
  • NPI 1225499015
  Medicare reassignment Care Compare group NPD
• Emergency Services Medical Corporation Coronado

  • Emergency Medicine Physician
  • Coronado, CA
  • NPI 1598395675
  Medicare reassignment Care Compare group
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Brawley, CA
  • NPI 1073554002
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Murrieta, CA
  • NPI 1588552848
  NPD
• Scripps Health

  dba Scripps Hospital Medical Services

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1487928891
  NPD

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

• Imperial Valley Healthcare District

  dba Pioneers Memorial Hospital

  • General Acute Care Hospital
  • Brawley, CA
  • NPI 1184429185
  Care Compare affiliation
• Sharp Coronado Hospital and Healthcare Center

  dba Sharp Coronado Hospital

  • General Acute Care Hospital
  • Coronado, CA
  • NPI 1154304475
  Care Compare affiliation

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

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628208000000",
    "number": "1194245662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921341098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921341098",
            "telephone_number": "970-640-5914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KEVIN",
        "middle_name": "BRIAN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-26",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "20A18937",
            "primary": true
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "CA",
            "license": "1194245662",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Philip Sullivan, M.D
• Julie Marie Sullivan, M.D.
• Kathy Rebecca Sullivan, IDC
• Keith Patrick Sullivan
• Kelly Ann Sullivan, M.A., M.F.T.
• Kyle Kathleen Sullivan
• Leigh Sullivan
• Liane Sullivan, MA, MFS
• Maggie Sullivan
• Makenna Sullivan

• Emergency Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.