Active NPI
Philip Sullivan, M.D.
- Psychiatry Physician
- Evanston, WY
National Provider Identifier
1790830792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 5348A
- Practice address
- 831 State Highway 150 S
Evanston, WY 82930-5340 - Phone
- (307) 789-3464
- Fax
- (307) 789-7373
- NPI assigned
- Jan 23, 2007
- Last updated
- Aug 5, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 5348A | WY | Primary |
Addresses
Primary practice location
831 State Highway 150 S
Evanston, WY 82930-5340
Mailing address
PO Box 177
Evanston, WY 82931-0177
Phone (307) 789-3464
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790830792 | Other | WY | NATIONAL PROVIDER IDENTIFICATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Wyoming | Past | Accepting new patients | |
| State of Alaska Department of Administration | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Alaska Psychiatric Institute
- Psychiatric Hospital
- Anchorage, AK
- NPI 1497842553
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312502400000",
"number": "1790830792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 177",
"city": "EVANSTON",
"state": "WY",
"postal_code": "829310177",
"telephone_number": "307-789-3464",
"fax_number": "307-789-7373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "831 STATE HIGHWAY 150 S",
"city": "EVANSTON",
"state": "WY",
"postal_code": "829305340",
"telephone_number": "307-789-3464",
"fax_number": "307-789-7373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "PHILIP",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2011-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WY",
"license": "5348A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL PROVIDER IDENTIFICATION",
"identifier": "1790830792",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evanston, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.