Dustin R Sulak, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO2142 Issued in ME

Practice address

964 Western Ave.
Manchester, ME 04351

Phone

(207) 512-8633

NPI assigned

Jul 14, 2008

Last updated

Jun 19, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jun 6, 2019 through Jun 6, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

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.

• Integr8 Health, LLC

  • Integrative Medicine Physician
  • Falmouth, ME
  • NPI 1073487286
  NPD Authorized official

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560902400000",
    "number": "1427212059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 U.S. ROUTE 1",
            "address_2": "SUITE 200",
            "city": "FALMOUTH",
            "state": "ME",
            "postal_code": "04105",
            "telephone_number": "207-482-0188",
            "fax_number": "888-642-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "964 WESTERN AVE.",
            "city": "MANCHESTER",
            "state": "ME",
            "postal_code": "04351",
            "telephone_number": "207-512-8633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULAK",
        "first_name": "DUSTIN",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-14",
        "last_updated": "2019-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "T0861",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "DO2142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "433021499",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terry Poland, RN
• Jean Marie Pratt, LCPC, LADC, CCS
• Prospect Inc.
• Rite Aid of Maine Inc (Rite Aid Pharmacy 04735)
• Angela Roy, RN
• Karin Thornton
• Derrick S Tooth, MD
• Amy M Vanhoey
• Peter J Volk, PA-C
• Walgreen Eastern Co Inc (Walgreens #17990)

• Family Medicine Physician in Manchester, ME
• Providers in Manchester, ME by specialty
• Family Medicine Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.