Brett Sullivan

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA064655 Issued in PA

Practice address

1000 E Mountain Dr
Wilkes Barre, PA 18711-0027

Phone

(570) 808-6000

Fax

(570) 808-6061

NPI assigned

Jun 13, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Geisinger Clinic

  • Family Medicine Physician
  • Danville, PA
  • NPI 1366493868
  Medicare reassignment
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023
  NPD
• Geisinger Clinic

  • Family Medicine Physician
  • Scranton, PA
  • NPI 1770990160
  NPD

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

{
    "created_epoch": "1686614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1649954355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E MOUNTAIN DR",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110027",
            "telephone_number": "570-808-6000",
            "fax_number": "570-808-6061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "BRETT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-13",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA064655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Suda
• Michelle K Sudo, DO
• Albert M Sukowaski, R.N.
• Mohanad Sulaiman, MD
• Annpat Sullivan, DPT
• Harley Breanna Sullivan
• Luke E. Sullivan, D.O.
• Christian Hailey Summa, DO
• Jennifer Summa, O.D.
• John J Sundbeck, M.A.

• Physician Assistant in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.

Verify at the official NPI Registry.