Active NPI
Edward M Sullivan, PA
- Physician Assistant
- Sunnyvale, TX
National Provider Identifier
1942209333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA01111
- Practice address
- 341 Wheatfield Dr
Suite 190
Sunnyvale, TX 75182-4638 - Phone
- (972) 686-8200
- Fax
- (972) 686-7711
- NPI assigned
- Jul 18, 2005
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA01111 | TX | Primary |
Addresses
Primary practice location
341 Wheatfield Dr
Suite 190
Sunnyvale, TX 75182-4638
Mailing address
3209 Willow BND
Bedford, TX 76021-3836
Phone (972) 686-8200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013069541 | Medicaid | TX |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01111 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284681600000",
"number": "1942209333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3209 WILLOW BND",
"city": "BEDFORD",
"state": "TX",
"postal_code": "760213836",
"telephone_number": "972-686-8200",
"fax_number": "972-686-7711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "341 WHEATFIELD DR",
"address_2": "SUITE 190",
"city": "SUNNYVALE",
"state": "TX",
"postal_code": "751824638",
"telephone_number": "972-686-8200",
"fax_number": "972-686-7711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "EDWARD",
"middle_name": "M",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-18",
"last_updated": "2010-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA01111",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1013069541",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sunnyvale, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.