Active NPI
Kamau Sullivan
- Clinical Social Worker
- Avon, IN
National Provider Identifier
1982385480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 99119013A
- Practice address
- 1928 S Dan Jones Rd
Avon, IN 46123-6678 - Phone
- (317) 854-8265
- NPI assigned
- Jul 27, 2023
- Last updated
- Jul 27, 2023
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 99119013A | IN | Primary |
Addresses
Primary practice location
1928 S Dan Jones Rd
Avon, IN 46123-6678
Mailing address
7829 Sailors LN
Indianapolis, IN 46254-9607
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 |
|---|---|---|---|
| 99119013A | IN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana Be Well, Inc. | Clinical | Current | Accepting new patients |
Locations
1928 S Dan Jones Rd
Avon, IN 46123
Phone (317) 509-4447
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1982385480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7829 SAILORS LN",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462549607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1928 S DAN JONES RD",
"city": "AVON",
"state": "IN",
"postal_code": "461236678",
"telephone_number": "317-854-8265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "KAMAU",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-07-27",
"last_updated": "2023-07-27",
"certification_date": "2023-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "99119013A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Avon, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.