Michael Jude Sullivan, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

15419 Issued in TN

Practice address

2204 Pavilion Dr Ste 108
Kingsport, TN 37660-4651

Phone

(423) 392-6100

Fax

(423) 392-0803

NPI assigned

Dec 14, 2005

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 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Gastroenterology

Education

Icahn School of Medicine at Mount Sinai, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sullivan and PTRSGroup PAC ID 5890875264, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.69 of 100Reported as group

Quality

85.87

Improvement activities

40

Cost

96.55

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sullivandigestivecenter@directaddress.net

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.

• Sullivan and PTRS

  • Gastroenterology Physician
  • Kingsport, TN
  • NPI 1003981093
  Medicare reassignment Care Compare group NPD
• Endoscopy Center of Kingsport

  • Endoscopy Clinic/Center
  • Kingsport, TN
  • NPI 1235140385
  NPD
• Tennessee Anesthesiology LLC

  • Certified Registered Nurse Anesthetist
  • Kingsport, TN
  • NPI 1619265550
  NPD

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1326023078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 PAVILION DR STE 108",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604651",
            "telephone_number": "423-392-6100",
            "fax_number": "423-392-6159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 PAVILION DR STE 108",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604651",
            "telephone_number": "423-392-6100",
            "fax_number": "423-392-0803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MICHAEL",
        "middle_name": "JUDE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-14",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "TN",
            "license": "15419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3006621",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECARE",
            "identifier": "000035347",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sullivandigestivecenter@directaddress.net",
            "affiliation": "Y",
            "endpointDescription": "Direct Message",
            "affiliationName": "Endoscopy Center of Kingsport",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2204 Pavilion Dr Ste 108",
            "city": "Kingsport",
            "state": "TN",
            "country_code": "US",
            "postal_code": "376604651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Viktor P Sulkowski, M.D.
• Sullivan and PTRS
• Sullivan County Regional Health Department
• Hugh M. Sullivan
• Lauren Sullivan, PHARMD
• Timothy James Sullivan Jr., M.D.
• Summer Days Therapy LLC
• Jeffrey A Summers, MD
• Summit Medical Group PLLC
• Zachary Linuel Sumpter, D.O.

• Gastroenterology Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Gastroenterology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; 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.
• 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.