NPIMap

Individual provider Active NPI

Clemence Marie Sullivan, M.D.

  • Internal Medicine Physician
  • Saint Louis Park, MN
National Provider Identifier
1225354681
Registry record updated Nov 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
58690 Issued in MN
Practice address
5100 Gamble Dr Ste 100
Mail Stop 31200a
Saint Louis Park, MN 55416-1582
Phone
(952) 541-2500
Fax
(952) 595-6455
NPI assigned
Apr 10, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 58690 MN Primary
Pediatrics Physician 208000000X 58690 MN

Addresses

Primary practice location

5100 Gamble Dr Ste 100
Mail Stop 31200a
Saint Louis Park, MN 55416-1582

Mailing address

PO Box 1309 - 8170 33Rd Ave S
Ms 21110Q
Minneapolis, MN 55425-4516
Phone (952) 541-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20141204002451 MN Practitioner - Internal MedicinePractitioner - Pediatric Medicine 7416279278 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

15350 English Ave
Apple Valley, MN 55124-6252
Phone (952) 431-8500

6845 Lee Ave N
Brooklyn Center, MN 55429-1717
Phone (763) 503-4400

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Care SVCS Home health agency, Minneapolis, MN, CCN 247151
  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
58690MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Dec 1, 2014 Accepting new patients
Group Health, Inc. Current Accepting new patients
Group Health, Inc. CurrentSince Dec 1, 2014 Accepting new patients
Park Nicollet Clinic Pediatrics Current Accepting new patients
Park Nicollet Clinic Pediatrics CurrentSince Mar 20, 2020 Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8170 33rd Ave S
Stop 21110Q
Minneapolis, MN 55425

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

1665 Utica Ave S
Ste 100
St Louis Park, MN 55416
Phone (952) 541-2500

Interoperability endpoints

  • Direct secure messaging: csullivan129223@direct.healthpartners.com

Organizations & group practices 5

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 7

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": "1270857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416268800000",
    "number": "1225354681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1309 - 8170 33RD AVE S",
            "address_2": "MS 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "952-541-2500",
            "fax_number": "952-595-6455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 GAMBLE DR STE 100",
            "address_2": "MAIL STOP 31200A",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554161582",
            "telephone_number": "952-541-2500",
            "fax_number": "952-595-6455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "CLEMENCE",
        "middle_name": "MARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-10",
        "last_updated": "2014-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "58690",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "58690",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis Park, MN

Sources for this page

Verify at the official NPI Registry.