JON M. SULLIVAN M.D. NPI 1053341370

NPI Information

NPI: 1053341370
Provider Name: JON M. SULLIVAN, M.D.
Classification: Pediatrics - 208000000X
Entity Type: Individual

PECOS Registration: Yes

Address:
100 JACKSON PIKE
GALLIPOLIS, OH
ZIP 45631
Phone: (740) 446-5371
Get Directions

Jon M. Sullivan, M.D. is a pediatrics in Gallipolis, OH. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. Jon M. Sullivan, M.D. NPI is 1053341370. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

100 JACKSON PIKE
GALLIPOLIS, OH
ZIP 45631-560
Phone: (740) 446-5371
Fax: (740) 446-5711

The NPI 1053341370 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/3/2006 and was last updated on 12/29/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		16987	WEST VIRGINIA	No
2	208000000X	Pediatrics		35-05-4754	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000000007592	OTHER		ANTHEM BCBS
2	310917085065	OTHER	OHIO	CARESOURCE MEDICAID #
3	0882719	OTHER	OHIO	MOLINA MEDICAID #
4	370002760	OTHER	OHIO	RR MEDICARE
5	001714064	OTHER		MOUNTAIN STATE BCBS
6	000000181879	OTHER	OHIO	UNISON MEDICAID #
7	0882719	MEDICAID	OHIO
8	0107833000	MEDICAID	WEST VIRGINIA
9	000000006810	OTHER	WEST VIRGINIA	ANTHEM BCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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