Len Sullivan, PA
Individual provider Active NPI Physician Assistant · Taylor, TX
NPI 1326198110 · NPPES record last updated Nov 1, 2023
Key facts
- NPI
- 1326198110
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA11712 (TX)
- Practice address
- 305 Mallard LN
Taylor, TX 76574-1208 - Phone
- (512) 352-7611
- Fax
- (512) 352-2196
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 25
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Brazos Emergency Medicine Associates PA
Concord Medical Group of Texas PLLC
Practice addresses (Care Compare)
1310 Paluxy Rd
Granbury, TX 76048-5655
Phone (817) 573-2273
704 Hospital Dr
Carrizo SPGS, TX 78834-3836
Phone (830) 876-2424
Hospital & facility affiliations
- Plains Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in CT, TX, NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111019000028 | CT | Practitioner - Physician Assistant | 5294736138 | Reassigns benefits to 5 organizations |
| I20180201000811 | TX | Practitioner - Physician Assistant | 5294736138 | Reassigns benefits to 12 organizations |
| I20240205002647 | NM | Practitioner - Physician Assistant | 5294736138 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 902 | MA | MD | Chiropractor |
| 00703 | CT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scott & White Hospital - Taylor | Physician Assistant | Current |
Accepting new patients |
| Dimmit Regional Hospital | Current |
Accepting new patients | |
| St. Vincents Urgent Care LLC | Current |
Accepting new patients | |
| Concord Medical Group of Texas PLLC | Current |
Accepting new patients | |
| Southwest General Emergency Physicians, PLLC | Physician Assistant | Current |
Accepting new patients |
| Dimmit Regional Hospital | Current |
Accepting new patients | |
| Orthopedic Associates of Hartford,PC | Current |
Accepting new patients | |
| Nes Arizona Inc | Current |
Accepting new patients | |
| Orthopedic Associates of Hartford,PC | Current |
Accepting new patients | |
| Bcep PA | Past | Accepting new patients |
Locations
31 Seymour St
Ste 100
Hartford, CT 06106
Phone (860) 549-8208
7365 Main St
Ste 7
Stratford, CT 06614
Phone (203) 696-3505
4311 E Lohman Ave
Las Cruces, NM 88011
Phone (505) 556-6800
405 W Country Club Rd
Roswell, NM 88201
Phone (505) 622-8170
200 S Geneva St
Breckenridge, TX 76424
Phone (254) 559-2241
704 Hospital Dr
Carrizo Springs, TX 78834
Phone (830) 876-2424
1313 Veterans Ave
Ste A
Crystal City, TX 78839
Phone (830) 374-9823
7400 Barlite Blvd
San Antonio, TX 78224
Phone (210) 921-2000
305 Mallard Ln
Taylor, TX 76574
Phone (512) 352-7611
2401 S 31st St
#200
Temple, TX 76508
Phone (254) 215-0100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 00703 | CT | |
| Medical Physician Assistant | 363AM0700X | 902 | MA | |
| Physician Assistant | 363A00000X | PA11712 | TX | Yes |
Addresses
Primary practice location
305 Mallard LN
Taylor, TX 76574-1208
Mailing address
PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-2111
Other practice location 1
Rte 75 AASF Bldge 154
Windsor Locks, CT 06096
Phone (860) 292-4711
Other providers in Taylor, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.