NPIMap

Individual provider Active NPI

Timothy Joseph Sullivan, M.D.

  • Family Medicine Physician
  • Lincoln, NE
National Provider Identifier
1376524611
Registry record updated Sep 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17443 Issued in NE
Practice address
1336 W a Ste a
Coddington Medical Family Practice
Lincoln, NE 68522-1231
Phone
(402) 438-0101
Fax
(402) 817-1245
NPI assigned
Nov 11, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17443 NE Primary

Addresses

Primary practice location

1336 W a Ste a
Coddington Medical Family Practice
Lincoln, NE 68522-1231

Mailing address

7711 W Walin LN
Lincoln, NE 68532-9200
Phone (402) 742-2502

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100511000916 NE Practitioner - Family Practice 8527098870 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nebraska College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coddington Medical Family Practice LLCGroup PAC ID 5991936841, 4 clinicians

Practice addresses (Care Compare)

1336 W a St
Suite a
Lincoln, NE 68522-1231
Phone (402) 438-0101

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Lincoln, NE, CCN 287060
  • CHI Health at Home - Lincoln Home health agency, Lincoln, NE, CCN 287050
  • Eventide Home Health Care Home health agency, Lincoln, NE, CCN 287002
  • Bryan Medical Center Hospital, Lincoln, NE, CCN 280003
  • CHI Health St. Elizabeth Hospital, Lincoln, NE, CCN 280020
  • Jefferson Community Health & Life Hospital, Fairbury, NE, CCN 281319
  • Thayer County Health Services Hospital, Hebron, NE, CCN 281304
  • Brodstone Healthcare Hospital, Superior, NE, CCN 281315
  • Madonna Rehabilitation Hospital Lincoln Inpatient rehabilitation facility, Lincoln, NE, CCN 283025

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions14
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17443NEMDFamily Medicine Physician

Interoperability endpoints

  • Direct secure messaging: timothysullivan@cmfp.allscriptsdirect.net

Organizations & group practices 1

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 11

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

NPI Registry JSON

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

{
    "created_epoch": "1131667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442534400000",
    "number": "1376524611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7711 W WALIN LN",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685329200",
            "telephone_number": "402-742-2502",
            "fax_number": "402-817-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1336 W A STE A",
            "address_2": "CODDINGTON MEDICAL FAMILY PRACTICE",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685221231",
            "telephone_number": "402-438-0101",
            "fax_number": "402-817-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "TIMOTHY",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-11",
        "last_updated": "2015-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "17443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.