Active NPI
Timothy Mark Sullivan, P.A.
- Physician Assistant
- Mesa, AZ
National Provider Identifier
1619152915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 9951 E El Moro Ave
Mesa, AZ 85208-5869 - Phone
- (602) 570-6428
- NPI assigned
- Jan 4, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | AZ | Primary |
Addresses
Primary practice location
9951 E El Moro Ave
Mesa, AZ 85208-5869
Mailing address
5432 E Southern Ave
Mesa, AZ 85206-2772
Phone (480) 325-3275
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3803 | AZ | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225843200000",
"number": "1619152915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5432 E SOUTHERN AVE",
"city": "MESA",
"state": "AZ",
"postal_code": "852062772",
"telephone_number": "480-325-3275",
"fax_number": "480-981-9123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9951 E EL MORO AVE",
"city": "MESA",
"state": "AZ",
"postal_code": "852085869",
"telephone_number": "602-570-6428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "TIMOTHY",
"middle_name": "MARK",
"name_prefix": "Mr.",
"credential": "P.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-04",
"last_updated": "2008-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.