Active NPI
C Eugene Sullivan, M.D.
- Specialist
- Boise, ID
National Provider Identifier
1649453903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- M3232
- Practice address
- 210 W Jefferson St
Boise, ID 83702-6044 - Phone
- (208) 344-9424
- Fax
- (208) 343-3263
- NPI assigned
- Dec 10, 2007
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | M3232 | ID | Primary |
Addresses
Primary practice location
210 W Jefferson St
Boise, ID 83702-6044
Mailing address
PO Box 2066
Boise, ID 83701-2066
Phone (208) 344-9424
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0024588 | Medicaid | ID |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M3232 | ID | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain States Oncology Group | 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.
-
- Nurse Practitioner
- Boise, ID
- NPI 1205093739
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197244800000",
"number": "1649453903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2066",
"city": "BOISE",
"state": "ID",
"postal_code": "837012066",
"telephone_number": "208-344-9424",
"fax_number": "208-344-3263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 W JEFFERSON ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837026044",
"telephone_number": "208-344-9424",
"fax_number": "208-343-3263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "C",
"middle_name": "EUGENE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-10",
"last_updated": "2007-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "ID",
"license": "M3232",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0024588",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.