South Pointe Pediatrics, PLLC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

23824 Issued in OK

Legal business name

SOUTH POINTE PEDIATRICS, PLLC

Practice address

1615 S Eucalyptus Ave
Suite 210
Broken Arrow, OK 74012-6159

Phone

(918) 254-6822

Fax

(918) 254-6823

NPI assigned

Jun 13, 2008

Last updated

Jan 10, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Julie G Sullivan, M.D.NPI 1578568010

Title

Owner

Phone

(918) 254-6822

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Julie Gail Sullivan, M.D.

  • Pediatric Adolescent Medicine Physician
  • Broken Arrow, OK
  • NPI 1578568010
  NPD (past) Authorized official

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

{
    "created_epoch": "1213315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484006400000",
    "number": "1235399122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 S EUCALYPTUS AVE",
            "address_2": "SUITE 210",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740126159",
            "telephone_number": "918-254-6822",
            "fax_number": "918-254-6823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 S EUCALYPTUS AVE",
            "address_2": "SUITE 210",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740126159",
            "telephone_number": "918-254-6822",
            "fax_number": "918-254-6823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH POINTE PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-13",
        "last_updated": "2017-01-10",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-254-6822",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "OK",
            "license": "23824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Douglas Solnok
• Jack Milton Sommers, MD, MBA
• Sooner Diagnostic & Neuro Testing
• Alessandra Soto
• Maritza Soto
• Southlake Dialysis LLC (Broken Arrow Dialysis Center)
• Southside Dermatology PLLC
• Sandra Souvannachak, PHARMD
• Karen Sparks
• Lindsay R Sparks, PTA

• Pediatric Adolescent Medicine Physician in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Pediatric Adolescent Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.