Bernard John Sullivan, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP-0436 Issued in KS

Practice address

10540 Marty St Ste 155
Overland Park, KS 66212-2654

Phone

(913) 451-2843

Fax

(913) 383-1088

NPI assigned

Mar 22, 2007

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Bernard J Sullivan PHD LLC

  • Clinical Psychologist
  • Overland Park, KS
  • NPI 1528183159
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528184306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10540 MARTY ST STE 155",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662122654",
            "telephone_number": "913-451-2843",
            "fax_number": "913-383-1088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10540 MARTY ST STE 155",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662122654",
            "telephone_number": "913-451-2843",
            "fax_number": "913-383-1088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "BERNARD",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KS",
            "license": "LP-0436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER",
            "identifier": "606084",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "07571-01-0",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sukaromya Vision LLC
• Manar Y Suker, MD
• Rebekah A Sukolics, DNP, CRNA
• Amanda Sullins, PHARMD
• Alaura Sullivan
• Charles M Sullivan, M.D.
• Kathyrn Sullivan, LPC
• Kevin D Sullivan
• Lara Sullivan, MD
• Madison Sullivan

• Clinical Psychologist in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Clinical Psychologist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.