Active NPI
John S Sullivan, MD
- Allergy Physician
- Worcester, MA
National Provider Identifier
1568466324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy Physician
- License
- 57446
- Practice address
- 100 MLK Jr Blvd
2ND Floor
Worcester, MA 01608-1209 - Phone
- (508) 757-1589
- Fax
- (508) 756-5633
- NPI assigned
- Jun 9, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy Physician | 207KA0200X | 57446 | MA | Primary |
Addresses
Primary practice location
100 MLK Jr Blvd
2ND Floor
Worcester, MA 01608-1209
Mailing address
100 MLK Jr Blvd
2ND Floor
Worcester, MA 01608-1209
Phone (508) 757-1589
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0200248 | Other | MA | UNITED HEALTH CARE |
| 057446 | Other | MA | TUFTS HEALTHPLAN |
| J30252 | Other | MA | BLUE CROSS BLUE SHIELD |
| 985163 | Other | MA | NETWORK HEALTH |
| 6189768 | Medicaid | MA | |
| 042923137 | Other | MA | TAX ID GROUP NUMBER |
| 645387 | Other | MA | HARVARD PILGRIM |
| 2376607 | Other | MA | AETNA HEALTHCARE |
| 26920 | Other | MA | CHILDREN'S MEDICAL SECURI |
| 63777 | Other | MA | FALLON HEALTH PLAN |
| 0029830 | Other | MA | NEIGHBORHOOD HEALTH PLAN |
| 326051 | Other | MA | CIGNA HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57446 | MA | MD | Allergy Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New England Pain Associates | Past | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220400000000",
"number": "1568466324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MLK JR BLVD",
"address_2": "2ND FLOOR",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016081209",
"telephone_number": "508-757-1589",
"fax_number": "508-756-5633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MLK JR BLVD",
"address_2": "2ND FLOOR",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016081209",
"telephone_number": "508-757-1589",
"fax_number": "508-756-5633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "JOHN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-09",
"last_updated": "2008-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "207KA0200X",
"taxonomy_group": "",
"desc": "Allergy & Immunology, Allergy",
"state": "MA",
"license": "57446",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "0200248",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTHPLAN",
"identifier": "057446",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "J30252",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH",
"identifier": "985163",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6189768",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID GROUP NUMBER",
"identifier": "042923137",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "645387",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HEALTHCARE",
"identifier": "2376607",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHILDREN'S MEDICAL SECURI",
"identifier": "26920",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON HEALTH PLAN",
"identifier": "63777",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEALTH PLAN",
"identifier": "0029830",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTHCARE",
"identifier": "326051",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.