NPIMap

Organization Active NPI

Sullivan Psychiatric Group, PLLC

  • Child & Adolescent Psychiatry Physician
  • Louisville, KY
National Provider Identifier
1366879025
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
21704 Issued in KY
Legal business name
SULLIVAN PSYCHIATRIC GROUP, PLLC
Practice address
4011 Gardiner Point Dr Ste 101
Louisville, KY 40213-1988
Phone
(502) 451-5121
Fax
(502) 451-5125
NPI assigned
Sep 26, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Authorized official

Name
John Paul Sullivan, MDNPI 1356355531
Title
Owner
Phone
(502) 451-5121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X
Child & Adolescent Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0804X 21704 KY Primary

Addresses

Primary practice location

4011 Gardiner Point Dr Ste 101
Louisville, KY 40213-1988

Mailing address

4011 Gardiner Point Dr
Suite 101
Louisville, KY 40213-1988
Phone (502) 451-5121

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180117001656 KY Part B Supplier - Clinic/Group Practice 4486913530 Receives reassigned benefits from 6 practitioners
Practice locations: Louisville, KY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1380153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1366879025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4011 GARDINER POINT DR",
            "address_2": "SUITE 101",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402131988",
            "telephone_number": "502-451-5121",
            "fax_number": "502-451-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4011 GARDINER POINT DR STE 101",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402131988",
            "telephone_number": "502-451-5121",
            "fax_number": "502-451-5125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN PSYCHIATRIC GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-26",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-451-5121",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "KY",
            "license": "21704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.