Tim B Osullivan, NP

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN154376 Issued in OH

Practice address

4444 Gregory Dr
Maumee, OH 43537-1822

Phone

(419) 893-7606

NPI assigned

Jul 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northeast Surgical Associates of Ohio LTD

  • Surgery Physician
  • Independence, OH
  • NPI 1184956138
  NPD (past)

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552953600000",
    "number": "1538169792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4444 GREGORY DR",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371822",
            "telephone_number": "419-893-7906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 GREGORY DR",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371822",
            "telephone_number": "419-893-7606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSULLIVAN",
        "first_name": "TIM",
        "middle_name": "B",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2019-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "154376",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN154376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "P00186819",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000379377",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2346634",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana L Orns-Grant, LISW
• Alexia Ortner, LPN
• Steven Michael Osborn, PHARMD, RPH
• Hannah Osenbaugh
• Nylah Osley, RBT
• Jason Russell Otto, T
• Marwa Ouasli, CNP
• Richard A. Paat, M.D.
• James C. Padgett, CRNA
• Logan Paduan, RN

• Registered Nurse in Maumee, OH
• Providers in Maumee, OH by specialty
• Registered Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.