Jay Cummings Sullivan, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

CA20A6641 Issued in CA

Practice address

3722 74TH Avenue CT NW
Gig Harbor, WA 98335-6446

Phone

(253) 682-8002

NPI assigned

Feb 7, 2009

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1233964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233964800000",
    "number": "1396984894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3722 74TH AVENUE CT NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983356446",
            "telephone_number": "253-682-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3722 74TH AVENUE CT NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983356446",
            "telephone_number": "253-682-8002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JAY",
        "middle_name": "CUMMINGS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-07",
        "last_updated": "2009-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "CA20A6641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily L Strovink
• Scott Walter Studerus, DDS
• Heidi Lyn Sturgeon
• Jesus Suarez, RN
• Suburban Obsyetrics and Gynecology P.S.
• Justine Elise Sullivan
• Kevin Jeremiah Sullivan, MD
• Preston Sullivan, MD
• Shay Sullivan, MS CF-SLP
• Bryce K Sumida, DPT

• Internal Medicine Physician in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2009; 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.