NPIMap

Individual provider Active NPI

Guy Sullivan, PA-C

  • Physician Assistant
  • Des Moines, IA
National Provider Identifier
1841642667
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
084075 Issued in IA
Practice address
450 Laurel St
Suite a
Des Moines, IA 50314-3045
Phone
(515) 247-8400
Fax
(515) 248-8888
NPI assigned
Jul 5, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1377 SD
Surgical Physician Assistant 363AS0400X 084075 IA
Physician Assistant 363A00000X 084075 IA Primary

Addresses

Primary practice location

450 Laurel St
Suite a
Des Moines, IA 50314-3045

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, SD2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160829002150 IA Practitioner - Physician Assistant 8527353622 Reassigns benefits to 1 organization
I20230816001345 SD Practitioner - Physician Assistant 8527353622 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Institute PCGroup PAC ID 1254223894, 57 clinicians

Practice addresses (Care Compare)

1101 Broadway Ave
Yankton, SD 57078-2835
Phone (605) 331-5890

2120 Live Stronger St
Tea, SD 57064-8331
Phone (605) 331-5890

407 22ND Ave
Brookings, SD 57006-2427
Phone (605) 331-5890

810 E 23Rd St
Sioux Falls, SD 57105-2135

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
78.77
Promoting interoperability
100
Improvement activities
40
Cost
70.49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
084075IAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iowa Orthopaedic Center, P.C. Physician Assistant CurrentSince Aug 1, 2016 Accepting new patients
Iowa Orthopaedic Center, P.C. Surgical CurrentSince Aug 1, 2016 Accepting new patients
Boone County Hospital Past Accepting new patients

Locations

710 E 1st St
Ankeny, IA 50021
Phone (515) 963-8723

450 Laurel St
Ste C
Des Moines, IA 50314
Phone (515) 247-9590

450 Laurel St
Ste A
Des Moines, IA 50314
Phone 5152478400321

1601 NW 114th St
Ste 353
Des Moines, IA 50325

500 Jefferson St
Ste A
Pella, IA 50219

5900 E University Ave
Ste 201
Pleasant Hill, IA 50327
Phone (515) 225-8180

Interoperability endpoints

  • Direct secure messaging: guy.sullivan.1@21545.direct.athenahealth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1467676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1841642667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 LAUREL ST",
            "address_2": "SUITE A",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503143045",
            "telephone_number": "515-247-8400",
            "fax_number": "515-248-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "GUY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-05",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "1377",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IA",
            "license": "084075",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "084075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.