Glenn R Sullivan, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810003867 Issued in VA

Practice address

30 Crossing LN Ste 101
Lexington, VA 24450-6354

Phone

(540) 463-2080

Fax

(540) 464-7648

NPI assigned

Mar 18, 2008

Last updated

Mar 19, 2018By 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 4

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Lexington Psychological Services, PLLC

  dba Glenn R. Sullivan, Ph.D.

  • Clinical Psychologist
  • Lexington, VA
  • NPI 1992209720
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1205798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521417600000",
    "number": "1871764779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 COLSTON PL",
            "city": "LEXINGTON",
            "state": "VA",
            "postal_code": "244501812",
            "telephone_number": "540-463-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 CROSSING LN STE 101",
            "city": "LEXINGTON",
            "state": "VA",
            "postal_code": "244506354",
            "telephone_number": "540-463-2080",
            "fax_number": "540-464-7648"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 E Washington St",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "VA",
            "postal_code": "244502562",
            "country_code": "US",
            "telephone_number": "540-464-7474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "108 Houston St Ste D",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "VA",
            "postal_code": "244502455",
            "country_code": "US",
            "telephone_number": "540-463-2080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "GLENN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-18",
        "last_updated": "2018-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810003867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHKEEPERS",
            "identifier": "923366841",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "336-841",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SC0001096",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1103398805",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Steckline, RPA-C
• Jacqueline Steffen, D.O.
• Kerri F Stillwell, PA-C
• Stonewall Pediatrics
• Heather Erdos Strong, OTR/L
• Molly Katherine Sutherland, FNP-C, ATC
• Carola Ann Tanna, M.D.
• Dominique Boone Tarber, PSY.D
• Tony Taylor Sr., PHARM D
• Zachary Ross Taylor, LPC

• Clinical Psychologist in Lexington, VA
• Providers in Lexington, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; 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.