Robert Sullivan, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD2007-0049 Issued in NM

Practice address

3900 Eubank Boulevard NE
Suite 9a
Albuquerque, NM 87111-3465

Phone

(505) 286-4492

Fax

(505) 286-4392

NPI assigned

Dec 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• May Pharmacy Cedar Crest Inc

  • Pharmacy
  • Cedar Crest, NM
  • NPI 1356364343
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291852800000",
    "number": "1598823049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POST OFFICE BOX 685",
            "city": "TIJERAS",
            "state": "NM",
            "postal_code": "870598229",
            "telephone_number": "505-286-4492",
            "fax_number": "505-286-4392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 EUBANK BOULEVARD NE",
            "address_2": "SUITE 9A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113465",
            "telephone_number": "505-286-4492",
            "fax_number": "505-286-4392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2010-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NM",
            "license": "MD2007-0049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "87670780",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Ann Sullivan, M.A.
• Krishawn Nicole Sullivan
• Linda J. Sullivan, DOM
• Matthew Austin Sullivan, MD
• Michael Sullivan, PHARM.D
• Tonia Sullivan, RN
• Celeste Baczeski Suminsby, WHNP
• Melo Summer Tafoya
• Mark A Summerlin, RD
• Erika Rae Summers, MS CCC SLP

• Psychiatry Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Psychiatry Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; 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.