Rita De-Haan Sullivan, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

965 Issued in OR

Practice address

201 W Main St
Suite 1B
Medford, OR 97501-2744

Phone

(541) 944-5711

NPI assigned

Nov 1, 2006

Sex

Female

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 OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Ontrack, Inc.

  • Community/Behavioral Health Agency
  • Medford, OR
  • NPI 1881685097
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494460800000",
    "number": "1417034794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4152",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975010154",
            "telephone_number": "541-944-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W MAIN ST",
            "address_2": "SUITE 1B",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975012744",
            "telephone_number": "541-944-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "RITA",
        "middle_name": "DE-HAAN",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2017-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrian Sue, MD
• Loralee D. Sue, MD
• David Sullivan, LMT
• Heather Sullivan, FNP
• Lynn C Sullivan, FNP
• Sandra Jane Sullivan
• Summer Waters, LLC
• Brett A. Summers, R.PH
• Robin Lynn Nicole Summers
• Summit Dermatology and Aesthetics

• Clinical Psychologist in Medford, OR
• Providers in Medford, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.