Stacey J Sullivan, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

32083 Issued in AZ

Practice address

9070 E Desert Cove Ave Ste A102
Scottsdale, AZ 85260-6227

Phone

(480) 553-6168

Fax

(480) 590-6235

NPI assigned

Jul 10, 2006

Sex

Female

Sole proprietor

No

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 AZ, TX2 enrollments

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.

Enrollment records 2

Specialty

Family Practice

Education

Rutgers New Jersey Medical School, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Salt River Pima-Maricopa Indian CommunityGroup PAC ID 6204078025, 43 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ssullivan701877@direct.ochin.org
• FHIR API: https://api.platform.athenahealth.com/20314/brand/1/csg/1/fhir/r4

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.

• Salt River Pima-Maricopa Indian Community

  • Community Health Clinic/Center
  • Scottsdale, AZ
  • NPI 1942668991

  TX

  Medicare reassignment Care Compare group NPD
• 4C Medical Group PLC

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1558654384

  Family Medicine

  Medicare reassignment NPD
• Irene Benn Medical Center

  • Clinic/Center
  • Moapa, NV
  • NPI 1841535317

  TX

  Medicare reassignment NPD
• 4C Medical Group PLC

  • Urgent Care Clinic/Center
  • Carefree, AZ
  • NPI 1669916607
  NPD
• Salt River Pima-Maricopa Indian Community

  • Community Health Clinic/Center
  • Scottsdale, AZ
  • NPI 1538583125
  NPD
• Synergy Physicians PLLC

  • Plastic and Reconstructive Surgery Physician
  • Scottsdale, AZ
  • NPI 1083271746

  Family Medicine

  NPD
• Kayenta Alternative Rural Hospital

  • General Acute Care Hospital
  • Tonalea, AZ
  • NPI 1740359108
  NPD (past)
• University Physicians Healthcare

  • Psychiatry Physician
  • Tucson, AZ
  • NPI 1730141243
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656979200000",
    "number": "1447284088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9070 E DESERT COVE AVE STE A102",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852606227",
            "telephone_number": "480-553-6168",
            "fax_number": "480-590-6235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9070 E DESERT COVE AVE STE A102",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852606227",
            "telephone_number": "480-553-6168",
            "fax_number": "480-590-6235"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16635 N 43rd Ave",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850532707",
            "country_code": "US",
            "telephone_number": "602-588-0316",
            "fax_number": "602-588-0463",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "STACEY",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "32083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie L Sullivan, M.S., SLP-CCC
• Logan Jon Sullivan, PT
• Megan M Sullivan, M.D.
• Shane Sullivan
• Shawn Michael Sullivan, D.O.
• Susan B Sullivan, RPH
• Kayla Dawn Sumberg, N.M.D.
• Sumer Statler Aeed, LLC
• Shayne Sumida, MD
• Joseph D Summers, M.D.

• Family Medicine Physician in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; 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.