NPIMap

Individual provider Active NPI

Ashley Sullivan, M.D.

  • Emergency Medicine Physician
  • Gallup, NM
National Provider Identifier
1346523685
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
69155 Issued in MN
Practice address
516 E Nizhoni Blvd
Gallup, NM 87301-5748
Phone
(505) 722-1000
NPI assigned
Sep 22, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4301098998 MI
Emergency Medicine Physician 207P00000X 69155 MN Primary
Student in an Organized Health Care Education/Training Program 390200000X MI

Addresses

Primary practice location

516 E Nizhoni Blvd
Gallup, NM 87301-5748

Mailing address

516 E Nizhoni Blvd
Gallup, NM 87301-5748
Phone (505) 722-1000

Other practice location 1

800 E 28th St # MR 11112
Minneapolis, MN 55407-3723
Phone (612) 863-4233

Other practice location 2

22101 Moross Rd
Detroit, MI 48236-2148
Phone (313) 343-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, MN, TX3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20140702001823 MI Practitioner - Emergency Medicine 6608091855 Reassigns benefits to 2 organizations
I20210622000245 MN Practitioner - Emergency Medicine 6608091855 Reassigns benefits to 3 organizations
I20210831000826 TX Practitioner - Emergency Medicine 6608091855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Care Consultants PAGroup PAC ID 5496640161, 105 clinicians

Practice addresses (Care Compare)

800 E 28TH St
Minneapolis, MN 55407-3723
Phone (612) 863-4000

Hospital & facility affiliations

  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057
  • Owatonna Hospital Hospital, Owatonna, MN, CCN 240069

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301098998MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Lake City Current Accepting new patients
DHHS,PHS,Naihs, Gallup Indian Medical Center CurrentSince May 22, 2021 Accepting new patients
Emergency Department Physicians, P.C. Emergency Medicine CurrentSince Jul 1, 2014 Accepting new patients
Allina Health System CurrentSince Mar 1, 2022 Accepting new patients
Emergency Care Consultants, PA Emergency Medicine CurrentSince Mar 1, 2022 Accepting new patients
Allina Health System CurrentSince Mar 1, 2022 Accepting new patients
Allina Health System Current Accepting new patients
Observation Emergency Physicians, P.C. Emergency Medicine CurrentSince Jul 1, 2014 Accepting new patients
Ecc Addiction & Toxicology Services LLC Past Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

4100 S River Rd
East China, MI 48054
Phone (810) 329-6677

27351 Dequindre Rd
Madison Hts, MI 48071
Phone (248) 967-7000

500 W Grant St
Lake City, MN 55041
Phone (651) 345-3321

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

800 E 28th St
#11112
Minneapolis, MN 55407
Phone (612) 863-4233

301 2nd St NE
New Prague, MN 56071
Phone (952) 758-4431

2855 Campus Dr
Plymouth, MN 55441
Phone (763) 577-7000

516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326

1629 E Division St
River Falls, WI 54022
Phone (715) 307-6000

Organizations & group practices 9

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.

Hospital & facility affiliations 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1346523685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 E NIZHONI BLVD",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015748",
            "telephone_number": "505-722-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 E NIZHONI BLVD",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015748",
            "telephone_number": "505-722-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 E 28th St # MR 11112",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554073723",
            "country_code": "US",
            "telephone_number": "612-863-4233",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "22101 Moross Rd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482362148",
            "country_code": "US",
            "telephone_number": "313-343-3400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "ASHLEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-22",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301098998",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "69155",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gallup, NM

Sources for this page

Verify at the official NPI Registry.