Shane Sullivan

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

6673 Issued in AZ

Practice address

10133 N 92ND St Ste 101
Scottsdale, AZ 85258-4556

Phone

(480) 584-3334

Fax

(480) 272-9369

NPI assigned

Nov 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

21.44 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

71.45

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Spinescottsdale, PLLC

  • Physical Therapy Clinic/Center
  • Scottsdale, AZ
  • NPI 1427283936
  Medicare reassignment NPD

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361145600000",
    "number": "1942371216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8776 E SHEA BLVD",
            "address_2": "SUITE 106-450",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852606629",
            "telephone_number": "480-584-3334",
            "fax_number": "480-272-9369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10133 N 92ND ST STE 101",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584556",
            "telephone_number": "480-584-3334",
            "fax_number": "480-272-9369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SHANE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-10",
        "last_updated": "2013-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "6673",
            "primary": true
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "AZ",
            "license": "6673",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290315",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Sullivan Robbins, HADE11185
• Helen Ruth Sullivan, APRN
• Katie L Sullivan, M.S., SLP-CCC
• Logan Jon Sullivan, PT
• Megan M Sullivan, M.D.
• Shawn Michael Sullivan, D.O.
• Stacey J Sullivan, M.D.
• Susan B Sullivan, RPH
• Kayla Dawn Sumberg, N.M.D.
• Sumer Statler Aeed, LLC

• Physical Therapist in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.