Sullivan K Smith, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

18081 Issued in TN

Practice address

1 Medical Center Blvd
Cookeville, TN 38501-4294

Phone

(931) 783-2334

Fax

(931) 783-2253

NPI assigned

Jun 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: sullivan.smith.1@10383.direct.athenahealth.com

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.

• Volunteer Medical Group, P.C.

  • Emergency Medicine Physician
  • Cookeville, TN
  • NPI 1801886999
  NPD (past) Authorized official
• Cumberland River Hospital Inc

  • Psychiatric Hospital Unit
  • Celina, TN
  • NPI 1073687448
  NPD (past)

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1356346605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "address_2": "PO BOX 938",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014294",
            "telephone_number": "931-783-2334",
            "fax_number": "931-783-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014294",
            "telephone_number": "931-783-2334",
            "fax_number": "931-783-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SULLIVAN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "18081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3100062",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Smith
• Ricky Allen Smith, MD
• Rosemarie Smith, RBT
• Sara Smith
• Stephanie Marie Smith, FNP-BC
• Tara Beth Smith, OTR/L
• Tera Smith, FNP
• Trueman David Smith, M.D.
• Tyler Stout Smith, PTA
• SNH Tenn Tenant LLC

• Family Medicine Physician in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.