Miriam Jill Sullivan, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036063951 Issued in IL

Practice address

800 E Carpenter St
Department of Radiology
Springfield, IL 62702-5324

Phone

(217) 544-6464

Fax

(217) 525-5671

NPI assigned

Aug 16, 2006

Sex

Female

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 3

Other names 1

• M. Jill Sullivan Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Springfield Radiologists SC

  • Diagnostic Radiology Physician
  • Springfield, IL
  • NPI 1134178502
  NPD (past)
• Cira Michigan PC

  • Diagnostic Radiology Physician
  • Escanaba, MI
  • NPI 1972141513
  NPD (past)

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234310400000",
    "number": "1851404768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 E MADISON ST STE 2C",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627013121",
            "telephone_number": "217-544-2149",
            "fax_number": "217-525-5671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E CARPENTER ST",
            "address_2": "DEPARTMENT OF RADIOLOGY",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025324",
            "telephone_number": "217-544-6464",
            "fax_number": "217-525-5671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MIRIAM",
        "middle_name": "JILL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2009-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036063951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36063951",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00028347",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "300015701",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "M. JILL",
            "last_name": "SULLIVAN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Sudha Prasad M.D.S.C.
• Nikki R Suits, LCSW
• Mohamad Hekmat Sukkari, MD
• Kafila A Suleiman, M.D
• Jerry L. Sullivan Jr., ATC
• Samantha Dehaan Sullivan, M.S.
• Shaylee Sullivan, FNP-BC
• Supriya Sullivan
• Sydney J Sullivan, DNP,FNP-BC
• Britanie Lee Sumpter

• Diagnostic Radiology Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.