Individual provider Active NPI

J Andy Sullivan, MD

  • Orthopaedic Surgery Physician
  • Oklahoma City, OK
National Provider Identifier
1962471045
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
10917 Issued in OK
Practice address
940 NE 13TH St
Oklahoma City, OK 73104-5008
Phone
(405) 271-6667
NPI assigned
Mar 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 10917 OK Primary

Addresses

Primary practice location

940 NE 13TH St
Oklahoma City, OK 73104-5008

Mailing address

1122 NE 13TH St
Ori236
Oklahoma City, OK 73117-1039
Phone (405) 271-1515

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060126000988 OK Practitioner - Orthopedic Surgery 0143234385 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Aug 26, 2010 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Aug 26, 2010 Accepting new patients
Ou Health Partners, Inc CurrentSince Feb 3, 2025 Accepting new patients
Ou Health Partners, Inc CurrentSince Feb 3, 2025 Accepting new patients
Ou Medicine Inc. Past Accepting new patients

Locations

1200 Childrens Ave
#3A
Oklahoma City, OK 73104

1200 Childrens Ave
Oklahoma City, OK 73104
Phone (405) 271-2429

825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864

1200 Childrens Ave
Ste 3A
Oklahoma City, OK 73104
Phone (405) 271-2669

940 NE 13th St
Oklahoma City, OK 73104
Phone (405) 271-2429

825 NE 13th St
Oklahoma City, OK 73104
Phone (405) 271-1500

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

Interoperability endpoints

  • Direct secure messaging: jsullivan27403@ouhealth.direct-ci.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962471045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 NE 13TH ST",
            "address_2": "ORI236",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731171039",
            "telephone_number": "405-271-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 NE 13TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045008",
            "telephone_number": "405-271-6667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "J",
        "middle_name": "ANDY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OK",
            "license": "10917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.