Thomas C. Sullivan, M.D.

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

A41748 Issued in CA

Practice address

400 Crestwood Cir
Suite L
Mena, AR 71953-5511

Phone

(479) 394-1414

Fax

(479) 394-2612

NPI assigned

Jun 30, 2006

Sex

Male

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 AR

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 1

Specialty

General Surgery

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mena Surgical ClinicGroup PAC ID 8123185725, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mena Regional Health System Hospital, Mena, AR, CCN 041334

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: thomas.sullivan@mmamscwicc.eclinicaldirectplus.com
• FHIR API: https://fhir4.healow.com/fhir/r4/DAHFAD

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.

• Mena Surgical Clinic

  • Surgery Physician
  • Mena, AR
  • NPI 1871738161
  Medicare reassignment Care Compare group NPD
• Thomas C. Sullivan, M.D., Inc.

  • Colon & Rectal Surgery Physician
  • San Diego, CA
  • NPI 1437185717
  NPD (past) Authorized official
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023
  NPD (past)

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

• Mena Hospital Commission

  • Critical Access Hospital
  • Mena, AR
  • NPI 1861449639
  Care Compare affiliation

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328572800000",
    "number": "1508895988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 MORROW ST N",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719532516",
            "telephone_number": "479-394-6100",
            "fax_number": "479-394-4577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CRESTWOOD CIR",
            "address_2": "SUITE L",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719535511",
            "telephone_number": "479-394-1414",
            "fax_number": "479-394-2612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "THOMAS",
        "middle_name": "C.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2012-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "CA",
            "license": "A41748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Rostollan PLLC Dba RFP
• Rebecca L Stewart, DDS
• Storm-Petrel Inpatient Services LLC
• Misti Strasner, RD
• Kassandra Kory Strother, PTA
• Kara Danielle Tedford, CNP
• Trista Tetro
• The Guidance Center - Mena Clinic
• The Guidance Center - Polk County Sats
• Brandi Titsworth, LPC

• Colon & Rectal Surgery Physician in Mena, AR
• Providers in Mena, AR by specialty
• Colon & Rectal Surgery Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; 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.