Active NPI
Gerald Michael Sullivan, PSYD
- Clinical Psychologist
- Palatine, IL
National Provider Identifier
1992921662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Practice address
- 228 E Northwest Hwy
Palatine, IL 60067-8107 - Phone
- (224) 659-2708
- Fax
- (847) 577-9952
- NPI assigned
- Apr 18, 2007
- 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 Psychologist | 103TC0700X | IL | Primary |
Addresses
Primary practice location
228 E Northwest Hwy
Palatine, IL 60067-8107
Mailing address
615 W Vine St
Arlington Heights, IL 60004-5341
Phone (847) 392-5948
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191009001698 | IL | Practitioner - Clinical Psychologist | 2961733779 | Practice locations: Inverness, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1989
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1642 W Colonial Pkwy
FL 2
Inverness, IL 60067-4725
Phone (224) 659-2708
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071-004295 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992921662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 W VINE ST",
"city": "ARLINGTON HEIGHTS",
"state": "IL",
"postal_code": "600045341",
"telephone_number": "847-392-5948",
"fax_number": "847-577-9952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "228 E NORTHWEST HWY",
"city": "PALATINE",
"state": "IL",
"postal_code": "600678107",
"telephone_number": "224-659-2708",
"fax_number": "847-577-9952"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "GERALD",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palatine, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.