Brian Sullivan, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

44270 Issued in MN

Practice address

2355 Highway 36 W Ste 100
Roseville, MN 55113-3905

Phone

(651) 292-2000

NPI assigned

Jul 20, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN, ND2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations (25 of 39)

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.

• Allina Health System

  • Obstetrics & Gynecology Physician
  • Buffalo, MN
  • NPI 1295272342
  Medicare reassignment NPD
• Allina Health System

  • Family Medicine Physician
  • Annandale, MN
  • NPI 1457657249
  Medicare reassignment NPD
• Carris Health - Redwood LLC

  • Emergency Medicine Physician
  • Redwood Falls, MN
  • NPI 1265914048
  Medicare reassignment NPD
• Fairview Clinics

  • Primary Care Clinic/Center
  • Minneapolis, MN
  • NPI 1346432218
  Medicare reassignment NPD
• Fairview Express Care

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  Medicare reassignment NPD
• Grand Itasca Clinic and Hospital

  • General Acute Care Hospital
  • Grand Rapids, MN
  • NPI 1669426631
  Medicare reassignment NPD
• Lac Qui Parle Clinic of Madison Inc

  • Rural Health Clinic/Center
  • Madison, MN
  • NPI 1144266156
  Medicare reassignment NPD
• Madison Healthcare Services

  • Critical Access Hospital
  • Madison, MN
  • NPI 1942246848
  Medicare reassignment NPD
• Range Regional Health Services

  • Clinic/Center
  • Hibbing, MN
  • NPI 1669569265
  Medicare reassignment NPD
• Ridgeview Medical Center

  • Certified Registered Nurse Anesthetist
  • Waconia, MN
  • NPI 1528364429
  Medicare reassignment NPD
• Tria Orthopaedic Center LLC

  • Orthopaedic Surgery Physician
  • Bloomington, MN
  • NPI 1518273085

  Diagnostic Radiology

  Medicare reassignment NPD
• P R Health Corporation

  • Critical Access Hospital
  • Park River, ND
  • NPI 1679669741
  Medicare reassignment NPD

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1780604835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W STE 100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133905",
            "telephone_number": "651-292-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W STE 100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133905",
            "telephone_number": "651-292-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4801 W 81st St",
            "address_2": "Suite 108",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "554371111",
            "country_code": "US",
            "telephone_number": "952-837-9700",
            "fax_number": "952-837-9701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9055 Springbrook Dr NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554335841",
            "country_code": "US",
            "telephone_number": "763-780-9155",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Thompson St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022370",
            "country_code": "US",
            "telephone_number": "651-292-2000",
            "fax_number": "651-292-2136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "44270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "832920600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suburban Imaging, LLC
• Suburban Radiologic Consultants, LTD.
• Suite Living Senior Care of Roseville
• Suite Living Senior Management
• Alexander Blake Sullivan, LCSW, LICSW, LIMHP
• Laura Marie Sullivan, RN, CNP
• Patrick P Sullivan, MD
• Craig Anthony Sulzdorf, DDS
• Summer Ventures
• Andrew J Sundblad, MD

• Diagnostic Radiology Physician in Roseville, MN
• Providers in Roseville, MN by specialty
• Diagnostic Radiology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; 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.