Active NPI
Richard Sullivan, PHD
- Psychologist
- Bloomington, MN
National Provider Identifier
1912932468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP4326
- Practice address
- 7920 Old Cedar Ave S
Bloomington, MN 55425-1207 - Phone
- (952) 851-1000
- Fax
- (952) 851-1092
- NPI assigned
- Jul 12, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP4326 | MN | Primary |
Addresses
Primary practice location
7920 Old Cedar Ave S
Bloomington, MN 55425-1207
Mailing address
1021 Bandana Blvd E
Suite 200
Saint Paul, MN 55108-5113
Phone (651) 642-2700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 459093700 | Medicaid | MN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rsullivan97788@excellian.direct.allina.com | Direct |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP4326 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1912932468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1021 BANDANA BLVD E",
"address_2": "SUITE 200",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551085113",
"telephone_number": "651-642-2700",
"fax_number": "651-642-9441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7920 OLD CEDAR AVE S",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554251207",
"telephone_number": "952-851-1000",
"fax_number": "952-851-1092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "RICHARD",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-12",
"last_updated": "2021-03-11",
"certification_date": "2021-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP4326",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "459093700",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rsullivan97788@excellian.direct.allina.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/PDF/TXT",
"address_1": "7920 Old Cedar Ave S",
"city": "Bloomington",
"state": "MN",
"country_code": "US",
"postal_code": "554251207",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.