Craig D Sullivan, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

042-0007006 Issued in VT

Practice address

63 Crescent Ave
Green Mountain Family Practice
Northfield, VT 05663-5704

Phone

(802) 485-4161

Fax

(802) 485-4163

NPI assigned

Dec 16, 2005

Last updated

Dec 4, 2014By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: csullivan235900@direct.uvmhealth.org

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.

• Central Vermont Medical Center Inc

  • Family Medicine Physician
  • Berlin, VT
  • NPI 1023028784
  Medicare reassignment NPD
• Green Mountain Family Practice

  • Primary Care Clinic/Center
  • Northfield, VT
  • NPI 1194701623
  Authorized official Same address or phone

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417651200000",
    "number": "1194701615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 547",
            "address_2": "CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT",
            "city": "BARRE",
            "state": "VT",
            "postal_code": "056410547",
            "telephone_number": "802-485-4161",
            "fax_number": "802-485-4163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 CRESCENT AVE",
            "address_2": "GREEN MOUNTAIN FAMILY PRACTICE",
            "city": "NORTHFIELD",
            "state": "VT",
            "postal_code": "056635704",
            "telephone_number": "802-485-4161",
            "fax_number": "802-485-4163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "CRAIG",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2014-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "042-0007006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005680",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine Dara Reyes, PHD, LAT, ATC
• Kendra Roby
• K. Martin Simon, DDS
• Kaitlin Austin Smith
• Leah Sophrin, MS, SLP-CCC
• Matthew Dutton Sullivan, M.D.
• Nancy Peters Sullivan, ARNP
• Nicole Therrien
• Erika Thomas
• Charles Wayne Thompson III, PHARMD

• Family Medicine Physician in Northfield, VT
• Providers in Northfield, VT by specialty
• Family Medicine Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.