NPIMap

Individual provider Active NPI

Paul S Sullivan, D.O.

  • Family Medicine Physician
  • West Hartford, CT
National Provider Identifier
1740200377
Registry record updated Dec 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
000527 Issued in CT
Practice address
345 N Main St
Suite 245
West Hartford, CT 06117-2515
Phone
(860) 236-3000
Fax
(860) 236-3002
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 000527 CT Primary

Addresses

Primary practice location

345 N Main St
Suite 245
West Hartford, CT 06117-2515

Mailing address

345 N Main St
Suite 245
West Hartford, CT 06117-2515
Phone (860) 236-3000

Other identifiers 1

IdentifierTypeStateIssuer
001005273MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20041029000320 CT Practitioner - Family Practice 9931161254 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

114 Woodland St
Hartford, CT 06105-1208
Phone (860) 714-4000

Hospital & facility affiliations

  • Trinity Health of New England at Home Home health agency, Hartford, CT, CCN 077005
  • Hartford Healthcare at Home Home health agency, East Hartford, CT, CCN 077041
  • St Francis Hospital & Medical Center Hospital, Hartford, CT, CCN 070002
  • Hartford Hospital Hospital, Hartford, CT, CCN 070025

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
000527CTMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Aug 31, 2015 Accepting new patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Aug 31, 2015 Accepting new patients

Locations

11 South Rd
Ste 200
Farmington, CT 06032
Phone (860) 246-4000

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

345 N Main St
Ste 245
West Hartford, CT 06117
Phone (860) 236-3000

Interoperability endpoints

  • Direct secure messaging: psullivan2389390@direct.trinity-health.org

Organizations & group practices 2

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 7

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450051200000",
    "number": "1740200377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 N MAIN ST",
            "address_2": "SUITE 245",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061172515",
            "telephone_number": "860-236-3000",
            "fax_number": "860-236-3002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 N MAIN ST",
            "address_2": "SUITE 245",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061172515",
            "telephone_number": "860-236-3000",
            "fax_number": "860-236-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "PAUL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2015-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "000527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001005273",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

Verify at the official NPI Registry.