Active NPI
Heather E. Sullivan, M.D.
- Family Medicine Physician
- Eastford, CT
National Provider Identifier
1578584165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 024767
- Practice address
- 108 County Rd
Eastford, CT 06242-7710 - Phone
- (860) 315-5740
- Fax
- (860) 315-5741
- NPI assigned
- Jul 21, 2006
- Last updated
- Apr 18, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 024767 | CT | Primary |
Addresses
Primary practice location
108 County Rd
Eastford, CT 06242-7710
Mailing address
108 County Road
PO Box 385
Eastford, CT 06242
Phone (860) 315-5740
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DO1247675 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150513001331 | CT | Order and Referring Only - Family Practice | 5294737417 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587168000000",
"number": "1578584165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 COUNTY ROAD",
"address_2": "PO BOX 385",
"city": "EASTFORD",
"state": "CT",
"postal_code": "06242",
"telephone_number": "860-315-5740",
"fax_number": "860-315-5741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 COUNTY RD",
"city": "EASTFORD",
"state": "CT",
"postal_code": "062427710",
"telephone_number": "860-315-5740",
"fax_number": "860-315-5741"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "HEATHER",
"middle_name": "E.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-21",
"last_updated": "2020-04-18",
"certification_date": "2020-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CT",
"license": "024767",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DO1247675",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eastford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2020; 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.