NPIMap

Individual provider Active NPI

Charles L Sullivan, MD

  • Orthopaedic Hand Surgery Physician
  • Missoula, MT
National Provider Identifier
1619929635
Registry record updated Sep 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
License
MED-PHYS-LIC-12035 Issued in MT
Practice address
2360 Mullan Rd
Suite C.
Missoula, MT 59808-1811
Phone
(406) 721-4436
Fax
(406) 721-6053
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Hand Surgery Physician 207XS0106X MED-PHYS-LIC-12035 MT Primary

Addresses

Primary practice location

2360 Mullan Rd
Suite C.
Missoula, MT 59808-1811

Mailing address

2360 Mullan Rd Ste C
Missoula, MT 59808-1811
Phone (406) 721-4436

Other practice location 1

6 13th Ave E
Polson, MT 59860-5315
Phone (406) 883-5680

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091006000634 MT Practitioner - Hand SurgeryPractitioner - Orthopedic Surgery 4284727132 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hand SurgeryAlso: Orthopedic Surgery
Education
University of Utah School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Missoula Bone and Joint LLCGroup PAC ID 3870583990, 57 clinicians

Practice addresses (Care Compare)

2360 Mullan Rd
Suite C
Missoula, MT 59808-1811
Phone (406) 721-4436

Hospital & facility affiliations

  • St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
  • Bitterroot Health - Daly Hospital Hospital, Hamilton, MT, CCN 271340
  • St Luke Community Hospital Hospital, Ronan, MT, CCN 271325
  • Community Medical Center Hospital, Missoula, MT, CCN 270023
  • Deer Lodge Medical Center Hospital, Deer Lodge, MT, CCN 271314

Merit-based Incentive Payment System (MIPS)

Final score
71.79 of 100Reported as individual
Quality
48.71
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper limb (arm) arthroscopy (minimally invasive joint repair)47
Removal of tissue1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
12035MTMDOrthopaedic Hand Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Missoula Bone & Joint, LLC Hand Surgery CurrentSince Sep 1, 2009 Accepting new patients
Orthopaedic Spine Surgeons Past Accepting new patients
Pediatric Orthopedic Associates Past Accepting new patients
Uou Pediatric Orthopedics Past Accepting new patients
University of Utah Orthopedic Consultants Hand Surgery Past Accepting new patients

Locations

330 N 10th St
Ste A
Hamilton, MT 59840
Phone (406) 360-6303

2360 Mullan Rd
Ste C
Missoula, MT 59808
Phone (406) 542-9695

Interoperability endpoints

  • FHIR API: https://mbnj.mmi.prod.fhir.ema-api.com/fhir/r4/

Organizations & group practices 5

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788652800000",
    "number": "1619929635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2360 MULLAN RD STE C",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081811",
            "telephone_number": "406-721-4436",
            "fax_number": "406-721-6053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 MULLAN RD",
            "address_2": "SUITE C.",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081811",
            "telephone_number": "406-721-4436",
            "fax_number": "406-721-6053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 13th Ave E",
            "address_purpose": "LOCATION",
            "city": "Polson",
            "state": "MT",
            "postal_code": "598605315",
            "country_code": "US",
            "telephone_number": "406-883-5680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "CHARLES",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2026-09-06",
        "certification_date": "2026-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "MT",
            "license": "MED-PHYS-LIC-12035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.