Ian Wright Sullivan, DO

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

036.152223 Issued in IL

Practice address

2160 S 1St Ave
Maywood, IL 60153-3328

Phone

(708) 216-5306

NPI assigned

Apr 20, 2015

Sex

Male

Sole proprietor

No

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 MA

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

Interventional Radiology

Education

Nova Southeastern College of Osteo Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pratt Radiology Associates IncGroup PAC ID 8820989411, 53 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tufts Medical Center Hospital, Boston, MA, CCN 220116
• Melrosewakefield Healthcare Hospital, Melrose, MA, CCN 220070

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: isullivan125900@direct.luhs.org

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.

• Pratt Radiology Associates, Inc

  • Diagnostic Radiology Physician
  • Boston, MA
  • NPI 1154361780
  Medicare reassignment Care Compare group NPD
• TMC Radiology Cra LLC

  • Diagnostic Radiology Physician
  • Boston, MA
  • NPI 1851046726
  Medicare reassignment NPD
• Loyola University Medical Center

  • General Acute Care Hospital
  • Maywood, IL
  • NPI 1376521575
  NPD
• Yorkrad LLC

  • Diagnostic Radiology Physician
  • York, ME
  • NPI 1326752817
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Melrosewakefield Healthcare, Inc.

  • General Acute Care Hospital
  • Medford, MA
  • NPI 1841290467
  Care Compare affiliation
• Tufts Medical Center, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1730132515
  Care Compare affiliation

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

{
    "created_epoch": "1429488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591488000000",
    "number": "1811384613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-5306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-5306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "IAN",
        "middle_name": "WRIGHT",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-20",
        "last_updated": "2020-06-07",
        "certification_date": "2020-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IL",
            "license": "036.152223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ali Sualeh
• Roxanna Michelle Suarez
• Courtney Kimi Suh, MD
• Eugene Suh, M.D.
• Aisha Suhaiba, MD
• Moira Sullivan, MD
• David Kee-Fung Sum, M.D.
• Hobie D Summers, M.D.
• Ying Sun, M.S.
• Juliana Shou-an Sung, MD

• Vascular & Interventional Radiology Physician in Maywood, IL
• Providers in Maywood, IL by specialty
• Vascular & Interventional Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2020; 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.