NPIMap

Individual provider Active NPI

Dennis J Sullivan, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Bridgton, ME
National Provider Identifier
1497770853
Registry record updated Mar 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
011964 Issued in ME
Practice address
55 Main St.
Suite 2
Bridgton, ME 04009
Phone
(207) 647-3633
Fax
(207) 647-5633
NPI assigned
Jul 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 011964 ME Primary

Addresses

Primary practice location

55 Main St.
Suite 2
Bridgton, ME 04009

Mailing address

PO Box 658
Bridgton, ME 04009
Phone (207) 647-3633

Other identifiers 1

IdentifierTypeStateIssuer
105900000MedicaidME

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040702000162 ME Practitioner - Orthopedic Surgery 6002893526 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Maine Medical CenterGroup PAC ID 2567379563, 344 clinicians

Practice addresses (Care Compare)

690 Minot Ave
Suite 1
Auburn, ME 04210-3922
Phone (207) 783-1328

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.94 of 100Reported as group
Quality
47.72
Promoting interoperability
99
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
84.57 of 100Reported as group
Quality
66.56
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
011964MEMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bridgton Hospital CurrentSince Oct 7, 2024 Accepting new patients
Central Maine Medical Center CurrentSince Oct 7, 2024 Accepting new patients
Bridgton Hospital CurrentSince Oct 7, 2024 Accepting new patients
Rumford Hospital CurrentSince Oct 7, 2024 Accepting new patients
Rumford Hospital CurrentSince Oct 7, 2024 Accepting new patients
Central Maine Medical Center CurrentSince Oct 7, 2024 Accepting new patients
Advanced Orthopaedics and Sports Medicine, LLC Sports Medicine Past Accepting new patients

Locations

690 Minot Ave
#1
Auburn, ME 04210
Phone (207) 783-1328

10 Hospital Dr
Bridgton, ME 04009
Phone (207) 647-6000

55 Main St
Bridgton, ME 04009
Phone (207) 647-2144

55 Main St
Ste 2
Bridgton, ME 04009
Phone (207) 647-3633

300 Main St
Lewiston, ME 04240
Phone (207) 795-2400

430 Franklin St
Rumford, ME 04276
Phone (207) 369-0146

420 Franklin St
Rumford, ME 04276
Phone (207) 364-4581

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/

Organizations & group practices 8

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.

Hospital & facility affiliations 4

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": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647820800000",
    "number": "1497770853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 658",
            "city": "BRIDGTON",
            "state": "ME",
            "postal_code": "04009",
            "telephone_number": "207-647-3633",
            "fax_number": "207-647-5633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 MAIN ST.",
            "address_2": "SUITE 2",
            "city": "BRIDGTON",
            "state": "ME",
            "postal_code": "04009",
            "telephone_number": "207-647-3633",
            "fax_number": "207-647-5633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "DENNIS",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "ME",
            "license": "011964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105900000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgton, ME

Sources for this page

Verify at the official NPI Registry.