Michael W. Sullivan, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

30828 Issued in KY

Practice address

1600 Spearhead Division Ave Dept 140
Fort Knox, KY 40122-5104

Phone

(502) 613-4605

Fax

(502) 613-4549

NPI assigned

Jun 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NE

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

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.

• County Medical Services Inc.

  • Rural Health Clinic/Center
  • Red Cloud, NE
  • NPI 1174570758
  NPD (past)
• Moscati Health Center PC

  • Family Medicine Physician
  • Hastings, NE
  • NPI 1679685291
  NPD (past)

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403568000000",
    "number": "1275576944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SPEARHEAD DIVISION AVE DEPT 140",
            "city": "FORT KNOX",
            "state": "KY",
            "postal_code": "401225104",
            "telephone_number": "502-613-4605",
            "fax_number": "502-613-4549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SPEARHEAD DIVISION AVE DEPT 140",
            "city": "FORT KNOX",
            "state": "KY",
            "postal_code": "401225104",
            "telephone_number": "502-613-4605",
            "fax_number": "502-613-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MICHAEL",
        "middle_name": "W.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2014-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "20770",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "37645020",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "KY",
            "license": "30828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47600743623",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47600743612",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47600743621",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47600743622",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jang Hoon Son
• James Clay Stephens, M.D.
• Kathleen Marie Stevens, ARNP
• Virginia Richards Stokes, MD
• Crystal Straseske
• Kalindee Michelle Tamayo, SOCIAL WORK
• Scot Alan Tebo, M.D.
• Bruce Howard Thompson, D.M.D.
• Joanna Rae Thompson
• Darin Frederick Tiner, DMD

• General Practice Physician in Fort Knox, KY
• Providers in Fort Knox, KY by specialty
• General Practice Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.