Tim Sullivan, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

C55917 Issued in CA

Practice address

12791 Cabezut Rd
Sonora, CA 95370-5926

Phone

(209) 532-5524

Fax

(209) 532-1513

NPI assigned

Sep 25, 2006

Reactivated

Jul 29, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Sonora Community Hospital

  • Radiation Oncology Clinic/Center
  • Sonora, CA
  • NPI 1891732418
  Medicare reassignment NPD
• Sonora Community Hospital

  • Community/Retail Pharmacy
  • Sonora, CA
  • NPI 1740582568
  NPD
• Sonora Community Hospital

  • General Acute Care Hospital
  • Sonora, CA
  • NPI 1780673376
  NPD
• Sonora Community Hospital

  • Family Medicine Physician
  • Groveland, CA
  • NPI 1356332274
  NPD (past)
• St. Mary'S Medical Center

  • General Acute Care Hospital
  • Blue Springs, MO
  • NPI 1487656054
  NPD (past)

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564358400000",
    "number": "1750481099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12791 CABEZUT RD",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705926",
            "telephone_number": "209-532-5524",
            "fax_number": "209-532-1513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12791 CABEZUT RD",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705926",
            "telephone_number": "209-532-5524",
            "fax_number": "209-532-1513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "TIM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2019-07-29",
        "deactivation_date": "2019-07-12",
        "reactivation_date": "2019-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "34411",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C55917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Sturgis, RN
• Jon Stutz, BSP
• David Yao Tek Su, MD
• Andrew Tyler Suess, PA
• Erik Suh
• William Joseph Sullivan, MFT
• Tracy Lynn Sundstrand
• Brittaney S Sutton, LVN
• Sharon Gaye Swaffar, LMFT
• Lynette Swanson, AMFT

• Pediatrics Physician in Sonora, CA
• Providers in Sonora, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2019; 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.