Kathryn F Sullivan, MD
Individual provider Active NPI Urology Physician · Travis Afb, CA
NPI 1487700167 · NPPES record last updated Sep 3, 2026
Key facts
- NPI
- 1487700167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Urology Physician 208800000X
- License
- 0101249048 (VA)
- Practice address
- 60 MDG
101 Bodin Circle
Travis Afb, CA 94535-1800 - Phone
- (707) 423-7401
- NPI assigned
- Jan 26, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 21
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Urology
- Education
- George Washington University School of Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Titus County Hospital District
Practice addresses (Care Compare)
2001 N Jefferson Ave
Suite 210
Mount Pleasant, TX 75455-2390
Phone (903) 434-7111
Hospital & facility affiliations
- Titus Regional Medical Center
- Clinch Valley Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in VA, MD, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141021002782 | VA | Practitioner - Urology | 2860631884 | Reassigns benefits to 3 organizations |
| I20230606001353 | MD | Practitioner - Urology | 2860631884 | Reassigns benefits to 1 organization |
| I20250827001487 | TX | Practitioner - Urology | 2860631884 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| V5135 | TX | MD | Urology Physician |
| 0101249048 | VA | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tidalhealth Specialty Care, LLC | Current |
Accepting new patients | |
| Fauquier Physician Practices LLC | Urology | Current |
Accepting new patients |
| Clinch Professional Physician Services LLC | Current |
Accepting new patients | |
| Titus County Hospital District | Current |
Accepting new patients | |
| Clinch Professional Physician Services LLC | Urology | Current |
Accepting new patients |
| Titus County Hospital District | Current |
Accepting new patients | |
| Tidalhealth Specialty Care, LLC | Past | Accepting new patients |
Locations
400 Eastern Shore Dr
Salisbury, MD 21804
Phone (410) 543-2255
100 E Carroll St
Salisbury, MD 21801
Phone (410) 543-7100
330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780
2001 N Jefferson Ave
Ste 210
Mt Pleasant, TX 75455
Phone (903) 434-7111
2001 N Jefferson Ave
Mt Pleasant, TX 75455
Phone (903) 434-8044
6719 Governor Gc Peery Hwy
Ste 1000
Richlands, VA 24641
Phone (276) 596-6715
6719 Governor Gc Peery Hwy
Ste 2450
Richlands, VA 24641
Phone (276) 596-6786
550 Hospital Dr
Warrenton, VA 20186
Phone (540) 316-5940
Interoperability endpoints
- kathryn.sullivan.1@19847.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | V5135 | TX | |
| Urology Physician | 208800000X | 0101249048 | VA | Yes |
Addresses
Primary practice location
60 MDG
101 Bodin Circle
Travis Afb, CA 94535-1800
Mailing address
101 Bodin Cir
Travis Afb, CA 94535-1809
Phone (720) 220-4403
Other practice location 1
2001 N Jefferson Ave Ste 210
Mount Pleasant, TX 75455-2390
Phone (903) 434-7111
Other practice location 2
8691 Stonewall Rd
Manassas, VA 20110-4510
Phone (571) 284-1430
Other providers in Travis Afb, CA
- Andrew David Strawbridge
- Phillip Andrew Strawbridge
- Alexander Sturrock
- Teddy Su
- Roshani Subedi
- Kristin Ruth Summerfelt
- Narayana K Swamy
- Janna Swanson
- Trever Symalla
- Laban Kipkurui Tabartet
All providers in Travis Afb, CA · Urology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.