Active NPI
Robert Carl Sullivan, ATC
- Health Educator
- Norfolk, NE
National Provider Identifier
1912387416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Educator
- License
- 452
- Practice address
- 1500 Koenigstein Ave
Norfolk, NE 68701-3664 - Phone
- (402) 992-1272
- NPI assigned
- Jun 1, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | 452 | NE | Primary |
Addresses
Primary practice location
1500 Koenigstein Ave
Norfolk, NE 68701-3664
Mailing address
1500 Koenigstein Ave
Norfolk, NE 68701-3664
Phone (402) 992-1272
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 452 | NE | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433116800000",
"number": "1912387416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 KOENIGSTEIN AVE",
"city": "NORFOLK",
"state": "NE",
"postal_code": "687013664",
"telephone_number": "402-992-1272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 KOENIGSTEIN AVE",
"city": "NORFOLK",
"state": "NE",
"postal_code": "687013664",
"telephone_number": "402-992-1272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "ROBERT",
"middle_name": "CARL",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-01",
"last_updated": "2015-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "NE",
"license": "452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.