Leo W Sullivan. II, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036068595 Issued in IL

Practice address

4500 Memorial Dr
Belleville, IL 62226-5360

Phone

(618) 257-5879

Fax

(618) 257-6740

NPI assigned

Feb 8, 2007

Last updated

Jan 6, 2016By the provider in NPPES

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Elgin, IL
  • NPI 1912283110
  Medicare reassignment NPD
• Emergency Services Midwest SC

  • Emergency Medicine Physician
  • Belleville, IL
  • NPI 1174024806
  Medicare reassignment NPD
• Cep America Illinois LLP

  • Emergency Medicine Physician
  • Shiloh, IL
  • NPI 1134587637
  NPD
• Cepamerica Illinois LLP

  • Emergency Medicine Physician
  • Springfield, IL
  • NPI 1871360297
  NPD
• Emergency Department Associates, P.C.

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1659319754
  NPD (past)
• Missouri Em-I Medical Services, P.C.

  • Nurse Practitioner
  • Saint Louis, MO
  • NPI 1528008976
  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452038400000",
    "number": "1851431670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 MONTEREY DR",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622692833",
            "telephone_number": "618-624-8701",
            "fax_number": "618-624-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265360",
            "telephone_number": "618-257-5879",
            "fax_number": "618-257-6740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN.",
        "first_name": "LEO",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2016-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036068595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "930008245",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Stump, OTR/L
• Barbara Ann Sudholt, M.D.
• Karen E Suguitan, CRNA
• Ayla Sulley
• Michael J Sullivan, PA-C
• Sanna Margareta Sundquist, M.D.
• Jasmin Sunny
• Support Systems and Services
• Surpassing the Rest Home Care
• Surpassing the Rest Home Care

• Emergency Medicine Physician in Belleville, IL
• Providers in Belleville, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.