NPIMap

Individual provider Active NPI

Mitchell Sullivan, MD

  • Family Medicine Physician
  • Lyndonville, VT
National Provider Identifier
1841292562
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
042-0012982 Issued in VT
Practice address
195 Industrial Pkwy
Lyndonville, VT 05851-4511
Phone
(802) 748-9501
Fax
(802) 748-3420
NPI assigned
Aug 12, 2005
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9367 NH
Family Medicine Physician 207Q00000X 042-0012982 VT Primary

Addresses

Primary practice location

195 Industrial Pkwy
Lyndonville, VT 05851-4511

Mailing address

PO Box 83
Lyndonville, VT 05851-0083
Phone (802) 748-9501

Other identifiers 7

IdentifierTypeStateIssuer
160094OtherNHCIGNA HEALTHCARE
0106084YPNH01OtherNHANTHEM BC/BS
5830418OtherAETNA GROUP
9367OtherNHSTATE LICENSE #
30008999MedicaidNH
930044719OtherRAILROAD MEDICARE
3073723MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141121000566 VT Practitioner - Family Practice 8022024108 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

195 Industrial Pkwy
Lyndonville, VT 05851-4511
Phone (802) 748-9501

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9367NHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Vermont Regional Hospital, Inc Current Accepting new patients
Northeastern Vermont Regional Hospital, Inc Current Accepting new patients
Northeastern Vermont Regional Hospital, Inc Current Accepting new patients
Northeastern Vermont Regional Hospital Inc. CurrentSince Sep 15, 2014 Accepting new patients
Northeastern Vermont Regional Hospital Inc. CurrentSince Sep 15, 2014 Accepting new patients
Northeastern Vermont Regional Hospital Inc Current Accepting new patients
Coos County Family Health Services, Inc. Family Medicine Past Accepting new patients

Locations

195 Industrial Pkwy
Lyndonville, VT 05851

195 Industrial Pkwy
#1
Lyndonville, VT 05851

1315 Hospital Dr
St Johnsbury, VT 05819
Phone (802) 748-3638

Organizations & group practices 7

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1841292562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 83",
            "city": "LYNDONVILLE",
            "state": "VT",
            "postal_code": "058510083",
            "telephone_number": "802-748-9501",
            "fax_number": "802-748-3420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 INDUSTRIAL PKWY",
            "city": "LYNDONVILLE",
            "state": "VT",
            "postal_code": "058514511",
            "telephone_number": "802-748-9501",
            "fax_number": "802-748-3420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MITCHELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "9367",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "042-0012982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTHCARE",
            "identifier": "160094",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "0106084YPNH01",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP",
            "identifier": "5830418",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "9367",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30008999",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "930044719",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3073723",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lyndonville, VT

Sources for this page

Verify at the official NPI Registry.