Michael John Sullivan, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

16840 Issued in NE

Practice address

609 O St
Aurora, NE 68818-1100

Phone

(402) 694-3171

Fax

(402) 694-2146

NPI assigned

Aug 3, 2006

Sex

Male

Sole proprietor

No

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.

• Memorial Community Health, Inc

  • Family Medicine Physician
  • Aurora, NE
  • NPI 1881603850

  Family Medicine, NE

  Medicare reassignment NPD
• Memorial Community Health Inc

  • Rural Health Clinic/Center
  • Aurora, NE
  • NPI 1083326193
  NPD

Medicare fee-for-service enrollment

Enrolled in NE

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michaelsullivan@mchi.cernerdirect.com

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1528076197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 O ST",
            "city": "AURORA",
            "state": "NE",
            "postal_code": "688181100",
            "telephone_number": "402-694-3171",
            "fax_number": "402-694-2146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 O ST",
            "city": "AURORA",
            "state": "NE",
            "postal_code": "688181100",
            "telephone_number": "402-694-3171",
            "fax_number": "402-694-2146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "16840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "0561",
            "state": "NE"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MICHAELSULLIVAN@mchi.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Memorial Community Health Inc Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "609 O St",
            "city": "Aurora",
            "state": "NE",
            "country_code": "US",
            "postal_code": "688181100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Philip Shively
• Mariah Sorensen, EDS
• Sozo Family Services
• Gloria Ann Spiehs, OT/L
• Carolyn Kay Sullivan
• Pamela S Thomas Peters, SLP
• Sheri L Thompson
• Timothy J Jones DDS PC
• U Save Pharmacy of Aurora Inc
• U Save Pharmacy of Aurora Inc

• All providers in Aurora, NE
• Family Medicine Physician in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.