NPIMap

Individual provider Active NPI

Phyllis L. Sullivan, DO

  • Family Medicine Physician
  • Shawnee, KS
National Provider Identifier
1386686434
Registry record updated Sep 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
05-24472 Issued in KS
Practice address
7405 Renner Rd
Ku Medwest
Shawnee, KS 66217-9414
Phone
(913) 588-8400
Fax
(913) 588-8413
NPI assigned
Jun 12, 2006
Last updated
Sep 13, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 05-24472 KS Primary
Family Medicine Physician 207Q00000X R1H49 MO

Addresses

Primary practice location

7405 Renner Rd
Ku Medwest
Shawnee, KS 66217-9414

Mailing address

2330 Shawnee Mission Pkwy
Medical Administrative Services of Ku Med, Ste. 312
Westwood, KS 66205-2005
Phone (913) 588-9000

Other identifiers 9

IdentifierTypeStateIssuer
481159444OtherJAYHAWK TAX ID
100231070BMedicaidKS
10001636401OtherCHP PROVIDER NUMBER
326972OtherFIRSTGUARD
P00052983OtherRR MEDICARE
13470888OtherBCBS
157695XXOtherPREFERRED CARE OF NY
25562039OtherBCBS KUMW UC
4331498OtherAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
05-24472KSMDFamily Medicine Physician
R1H49MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jayhawk Primary Care Inc Family Medicine Past Accepting new patients
Jayhawk Primary Care Inc Family Medicine Past Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients
Jayhawk Primary Care Inc Family Medicine Past Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients
Jayhawk Primary Care Inc Family Medicine Past Accepting new patients
Jayhawk Primary Care Inc Family Medicine Past Accepting new patients
Jayhawk Primary Care Inc Past Accepting new patients
Jayhawk Primary Care Inc Family Medicine Past Accepting new patients

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315872000000",
    "number": "1386686434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 SHAWNEE MISSION PKWY",
            "address_2": "MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312",
            "city": "WESTWOOD",
            "state": "KS",
            "postal_code": "662052005",
            "telephone_number": "913-588-9000",
            "fax_number": "913-588-9822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7405 RENNER RD",
            "address_2": "KU MEDWEST",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662179414",
            "telephone_number": "913-588-8400",
            "fax_number": "913-588-8413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "PHYLLIS",
        "middle_name": "L.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2011-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "05-24472",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R1H49",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JAYHAWK TAX ID",
            "identifier": "481159444",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100231070B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHP PROVIDER NUMBER",
            "identifier": "10001636401",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTGUARD",
            "identifier": "326972",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00052983",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "13470888",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE OF NY",
            "identifier": "157695XX",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KUMW UC",
            "identifier": "25562039",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4331498",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; 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.