Brian R Summers, D.D.S.,M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

5854 Issued in NC

Practice address

108 Oakmont Dr
Greenville, NC 27858-5936

Phone

(252) 756-1456

Fax

(252) 317-8335

NPI assigned

Nov 7, 2006

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 NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255400172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4203 STERLING TRACE DR",
            "city": "WINTERVILLE",
            "state": "NC",
            "postal_code": "285909323",
            "telephone_number": "252-756-3538",
            "fax_number": "252-317-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 OAKMONT DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278585936",
            "telephone_number": "252-756-1456",
            "fax_number": "252-317-8335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERS",
        "first_name": "BRIAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S.,M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NC",
            "license": "5854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "98211",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Catherine Sullivan, RD, LDN, MPH
• Tiara Shannelle Sullivan, LCAS-A, LCMHCA
• Ursula Lynell Sullivan, PA-C
• Minnie Lue Sumerlin, FNP
• Summers and Johnson Periodontal Partnership
• Lisa Summers
• Sunshine Theraputic Services, LLC
• Kajuan Supel, M.A, BCBA, LBA
• Supports Plus LLC
• Tyler Surdi, PHARMD

• Periodontics in Greenville, NC
• Providers in Greenville, NC by specialty
• Periodontics in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.