Terrence R Sullivan, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

G25099 Issued in CA

Practice address

16450 Matilija Dr
Los Gatos, CA 95030-3080

Phone

(408) 590-3159

NPI assigned

Sep 1, 2005

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

Other identifiers 1

Other names 1

• Terry Sullivan Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tsullivan126037@santaclaravalley.direct-ci.net
• Direct secure messaging: tsullivan6766@icare.elcaminohospital.org

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.

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  NPD (past)

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1447244785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16450 MATILIJA DR",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950303080",
            "telephone_number": "408-590-3159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16450 MATILIJA DR",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950303080",
            "telephone_number": "408-590-3159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "TERRENCE",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "G25099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00061715",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERRY",
            "last_name": "SULLIVAN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brindha Krishna Subramanian, B.D.S, M.S
• Sergey Sukhanov
• Danielle L. Sukonick, M.D.
• Courtney Allison Sullivan, DPT
• Michael F. Sullivan, P.T.
• Suman S Kuppahally, M.D. Inc
• Jodecia Sung, DC
• Sutter Bay Medical Foundation
• Sutter Bay Medical Foundation
• Lauren Jeanette Swaney

• Urology Physician in Los Gatos, CA
• Providers in Los Gatos, CA by specialty
• Urology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; 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.