Gerald Edward Sullivan, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

37202 Issued in WI

Practice address

6040 W Lisbon Ave
Suite 200
Milwaukee, WI 53210-2116

Phone

(414) 447-9890

Fax

(414) 447-9891

NPI assigned

May 30, 2007

Last updated

Aug 12, 2019By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

Internal Medicine

Education

Medical College of Wisconsin, 1994

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sullivanmedicalclinic.geraldsullivan@134060.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sullivan Medical Clinic, LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Milwaukee, WI
  • NPI 1205263159
  Medicare reassignment NPD Authorized official
• Matters of the Spirit LLC

  • Clinic/Center
  • Brookfield, WI
  • NPI 1649661711
  Medicare reassignment NPD
• Amri Counseling Services, LLC

  • Community/Behavioral Health Agency
  • Milwaukee, WI
  • NPI 1497982045
  Medicare reassignment
• Word of Hope Ministries

  • Addiction (Substance Use Disorder) Counselor
  • Milwaukee, WI
  • NPI 1023351947
  Authorized official Same address or phone
• Center for Quality Community Life, Inc.

  • Case Management Agency
  • Milwaukee, WI
  • NPI 1437408044
  NPD (past)

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1760683551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1169 N 13TH AVE",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530901701",
            "telephone_number": "262-306-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6040 W LISBON AVE",
            "address_2": "SUITE 200",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532102116",
            "telephone_number": "414-447-9890",
            "fax_number": "414-447-9891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "GERALD",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-30",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "37202",
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "WI",
            "license": "37202",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32475500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abbey Sullivan, PA-C
• Amanda Renee Sullivan, AGACNP
• Bridget Rose Gross Sullivan, M.D.
• Connor William Sullivan, M.D.
• Dennis M Sullivan, MD
• Jordan Sullivan, DPM
• Julie Sullivan, M.D
• Katie Sullivan, MD
• Marcia Sullivan, NP
• Monica Sullivan, PA-C

• Internal Medicine Physician in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Internal Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.