NPIMap

Individual provider Active NPI

Scott F Sullivan, PA

  • Physician Assistant
  • East Providence, RI
National Provider Identifier
1477592988
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA826 Issued in MA
Practice address
450 Veterans Memorial Pkwy # 15B
East Providence, RI 02914-5300
Phone
(401) 434-3350
Fax
(401) 434-5230
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA00259 RI
Physician Assistant 363A00000X PA826 MA Primary

Addresses

Primary practice location

450 Veterans Memorial Pkwy # 15B
East Providence, RI 02914-5300

Mailing address

Provider Enrollment 41 Mall Road
Burlington, MA 01805-0001

Other practice location 1

118 Dudley St
Providence, RI 02905-2403
Phone (401) 273-4155

Other practice location 2

41 Mall Rd
Burlington, MA 01805-2403
Phone (781) 744-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, RI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040816000799 MA Practitioner - Physician Assistant 2860465192 Reassigns benefits to 4 organizations
I20080522000060 RI Practitioner - Physician Assistant 2860465192 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
VMD Primary Providers of Rhode Island PCGroup PAC ID 3072913714, 51 clinicians

Practice addresses (Care Compare)

106 Nate Whipple Hwy
Suite 101
Cumberland, RI 02864-1403
Phone (401) 658-2020

450 Veterans Memorial Pkwy
Suite 15B
East Providence, RI 02914-5300
Phone (401) 434-3350

Hospital & facility affiliations

  • The Miriam Hospital Hospital, Providence, RI, CCN 410012
  • Rhode Island Hospital Hospital, Providence, RI, CCN 410007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
000594CTMDAudiologist
PA826MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Beth Israel Lahey Health Primary Care Inc CurrentSince Dec 13, 2024 Accepting new patients
Beth Israel Lahey Health Primary Care, Inc. CurrentSince Dec 13, 2024 Accepting new patients
Musculoskeletal Institute Inc. Past Accepting new patients
Advantage Physical Therapy Past Accepting new patients
Memorial Hospital Past Accepting new patients
University Orthopedics, Inc. Past Accepting new patients
Coastal Medical Inc Past Accepting new patients

Locations

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400

15 Railroad Ave
South Hamilton, MA 01982
Phone (978) 468-7381

Interoperability endpoints

  • Direct secure messaging: scott.sullivan.1@31278.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/10729/brand/1/csg/1/fhir/r4

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1477592988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PROVIDER ENROLLMENT 41 MALL ROAD",
            "city": "BURLINGTON",
            "state": "MA",
            "postal_code": "018050001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 VETERANS MEMORIAL PKWY # 15B",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029145300",
            "telephone_number": "401-434-3350",
            "fax_number": "401-434-5230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "118 Dudley St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029052403",
            "country_code": "US",
            "telephone_number": "401-273-4155",
            "fax_number": "401-273-4115",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "41 Mall Rd",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "MA",
            "postal_code": "018052403",
            "country_code": "US",
            "telephone_number": "781-744-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SCOTT",
        "middle_name": "F",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA00259",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Providence, RI

Sources for this page

Verify at the official NPI Registry.