Pamela J Sullivan, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

12090 Issued in WV

Practice address

1 Medical Center Drive
Clarksburg, WV 26301-4199

Phone

(304) 623-3461

Fax

(304) 623-7666

NPI assigned

Feb 9, 2006

Sex

Female

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Valley Comprehensive Community Mental Health Center

  • Community/Behavioral Health Agency
  • Morgantown, WV
  • NPI 1154740660
  NPD (past)
• Valley Comprehensive Community Mental Health Center, Inc.

  • Mental Health Counselor
  • Morgantown, WV
  • NPI 1861476350
  NPD (past)
• West Virginia University Medical Corporation

  • Community/Behavioral Health Agency
  • Martinsburg, WV
  • NPI 1174233530
  NPD (past)

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334016000000",
    "number": "1356314306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DRIVE",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263014199",
            "telephone_number": "304-623-3461",
            "fax_number": "302-623-7666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DRIVE",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263014199",
            "telephone_number": "304-623-3461",
            "fax_number": "304-623-7666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "PAMELA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-09",
        "last_updated": "2012-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WV",
            "license": "12090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "260024338",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0116952000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Austin Carl Strickland, PHARMD
• Carlina Stuart
• Betty Jane Stull
• Nancy S Stull, PA-C
• Hollie Stutler
• Crystal Dawn Summerfield
• Donald E Summers, PH.D.
• Logan Nicholas Summers
• Dawn Marie Surock
• Roger Phillip Suter II, DDS

• Psychiatry Physician in Clarksburg, WV
• Providers in Clarksburg, WV by specialty
• Psychiatry Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2012; 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.