Kenneth W Sullivan, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

27509 Issued in TN

Practice address

3511 Old Clarksville Pike
Joelton, TN 37080-8892

Phone

(615) 299-5341

Fax

(615) 299-5386

NPI assigned

Oct 3, 2006

Last updated

Jun 9, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sullivan Family Practice, Inc.

  • Family Medicine Physician
  • Joelton, TN
  • NPI 1679914683
  NPD Authorized official

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433808000000",
    "number": "1376637215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 57",
            "city": "SPRINGFIELD",
            "state": "TN",
            "postal_code": "371720057",
            "telephone_number": "615-299-5341",
            "fax_number": "615-299-5386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3511 OLD CLARKSVILLE PIKE",
            "city": "JOELTON",
            "state": "TN",
            "postal_code": "370808892",
            "telephone_number": "615-299-5341",
            "fax_number": "615-299-5386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KENNETH",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2015-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "27509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premium Trucking & Logistics, LLC
• Rebecca Womack
• Rnlife Lab and Wellness
• Ronnie Felts
• Sullivan Family Practice, Inc.
• Tennessee Mediride LLC
• Autumn Tucker, BSW
• Wingo Family Dentistry
• Robert Daniel Wingo, D.D.S.
• Robert Wesley Wingo, DDS

• Family Medicine Physician in Joelton, TN
• Providers in Joelton, 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 Jun 9, 2015; 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.