Active NPI
William M Sullivan, M.D.
- Psychiatry Physician
- Portland, ME
National Provider Identifier
1487736377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 12321
- Practice address
- 144 State St
Portland, ME 04101-3776 - Phone
- (207) 799-0457
- Fax
- (207) 799-0457
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 12321 | ME | Primary |
Addresses
Primary practice location
144 State St
Portland, ME 04101-3776
Mailing address
29 Hunts Point Rd
Cape Elizabeth, ME 04107-2926
Phone (207) 799-0457
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12321 | ME | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catholic Charities Maine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Portland, ME
- NPI 1013955947
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290038400000",
"number": "1487736377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 HUNTS POINT RD",
"city": "CAPE ELIZABETH",
"state": "ME",
"postal_code": "041072926",
"telephone_number": "207-799-0457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "144 STATE ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041013776",
"telephone_number": "207-799-0457",
"fax_number": "207-799-0457"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "WILLIAM",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2010-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "ME",
"license": "12321",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.