NPIMap

Individual provider Active NPI

Clyde Sullivan II, M.D.

  • Cardiovascular Disease Physician
  • McKinney, TX
National Provider Identifier
1295939262
Registry record updated Jul 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
N6695 Issued in TX
Practice address
7850 Collin McKinney Pkwy
Suite 120
McKinney, TX 75070-2140
Phone
(469) 854-8920
Fax
(469) 854-8923
NPI assigned
Jun 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2866626-S150 OH
Cardiovascular Disease Physician 207RC0000X N6695 TX Primary

Addresses

Primary practice location

7850 Collin McKinney Pkwy
Suite 120
McKinney, TX 75070-2140

Mailing address

7850 Collin McKinney Pkwy
Suite 120
McKinney, TX 75070-2140
Phone (469) 854-8920

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20240510002118 IA Practitioner - Cardiovascular Disease (Cardiology) 5193876464 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shenandoah Medical Center 52 clinicians

Practice addresses (Care Compare)

1 Jack Foster Dr
Shenandoah, IA 51601-4586
Phone (712) 246-7240

300 Pershing Ave
Shenandoah, IA 51601-2355
Phone (712) 246-1230

Hospital & facility affiliations

  • Shenandoah Medical Center Hospital, Shenandoah, IA, CCN 161366
  • Shenandoah Medical Center Nursing home, CCN 16Z366

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2866626-S150OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shenandoah Medical Center Current Accepting new patients
Shenandoah Medical Center Current Accepting new patients
Shenandoah Medical Center CurrentSince Mar 13, 2024 Accepting new patients
Shenandoah Medical Center Current Accepting new patients
Shenandoah Medical Center Internal Medicine CurrentSince Mar 13, 2024 Accepting new patients
The New London Hospital Association, Inc. Past Accepting new patients
Sierra Vista Hospital Past Accepting new patients
Ashley Valley Physician Practice, LLC Internal Medicine Past Accepting new patients
St Mary'S Hospital and Medical Center, Inc Past Accepting new patients
Texas Health Physicians Group Past Accepting new patients

Locations

300 Pershing Ave
Shenandoah, IA 51601
Phone (712) 246-1230

1 Jack Foster Dr
Shenandoah, IA 51601
Phone (712) 246-7240

Interoperability endpoints

  • Direct secure messaging: cdsulliv@yourcarecommunity.org

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 2

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": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280361600000",
    "number": "1295939262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7850 COLLIN MCKINNEY PKWY",
            "address_2": "SUITE 120",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750702140",
            "telephone_number": "469-854-8920",
            "fax_number": "469-854-8923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7850 COLLIN MCKINNEY PKWY",
            "address_2": "SUITE 120",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750702140",
            "telephone_number": "469-854-8920",
            "fax_number": "469-854-8923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "CLYDE",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-13",
        "last_updated": "2010-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "2866626-S150",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "N6695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McKinney, TX

Sources for this page

Verify at the official NPI Registry.