NPIMap

Individual provider Active NPI

Sean W Sullivan, DO

  • Physical Medicine & Rehabilitation Physician
  • Watervliet, MI
National Provider Identifier
1194762286
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
5101014473 Issued in MI
Practice address
400 Medical Park Dr
Watervliet, MI 49098-9225
Phone
(269) 463-3600
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 5101014473 MI Primary

Addresses

Primary practice location

400 Medical Park Dr
Watervliet, MI 49098-9225

Mailing address

2000 Green Rd
Suite 300
Ann Arbor, MI 48105-1598

Other identifiers 3

IdentifierTypeStateIssuer
4714970MedicaidMI
4720636MedicaidMI
SS014473OtherMIBLUE CROSS BLUE SHIELD

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
I20050303000169 MI Practitioner - Family PracticePractitioner - Physical Medicine and RehabilitationPractitioner - Emergency Medicine 5597718486 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Physical Medicine and Rehabilitation
Education
Michigan State University College of Osteopathic Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeland Community Hospital Watervliet 66 clinicians

Practice addresses (Care Compare)

400 Medical Park Dr
Watervliet, MI 49098-9225
Phone (269) 463-3600

Hospital & facility affiliations

  • Corewell Health Lakeland Hospitals St Joseph Hospital Home health agency, Benton Harbor, MI, CCN 237163
  • Corewell Health Watervliet Hospital Hospital, Watervliet, MI, CCN 230078
  • Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
  • Community Rehabilitation Center Inpatient rehabilitation facility, Watervliet, MI, CCN 23T078

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101014473MIMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Assoc of Southwestern Michigan, PC Current Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince May 1, 2024 Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince May 1, 2024 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Oct 1, 2015 Accepting new patients
Lakeland Community Hospital Watervliet Family Medicine Current Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Oct 1, 2015 Accepting new patients
Lakeland Medical Practices Past Accepting new patients
Lakeland Community Hospital Watervliet Past Accepting new patients
Lakeland Community Hospital Watervliet Family Medicine Past Accepting new patients

Locations

7040 Red Arrow Hwy
Coloma, MI 49038
Phone (269) 468-4318

31 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 428-2417

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

460 Medical Park Dr
Ste 200
Watervliet, MI 49098

400 Medical Park Dr
Watervliet, MI 49098
Phone (269) 463-3111

Interoperability endpoints

  • Direct secure messaging: ssullivan1272222@epic00.corewelldirect.org
  • FHIR API: https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1194762286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 GREEN RD",
            "address_2": "SUITE 300",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481051598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MEDICAL PARK DR",
            "city": "WATERVLIET",
            "state": "MI",
            "postal_code": "490989225",
            "telephone_number": "269-463-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SEAN",
        "middle_name": "W",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "5101014473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4714970",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4720636",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "SS014473",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watervliet, MI

Sources for this page

Verify at the official NPI Registry.