Cory Raymond Sullivan, ASW is a medicare enrolled "Social Worker - Clinical" provider in Pomona, California. His current practice location is
2008 N Garey Ave, Pomona, California. You can reach out to his office (for appointments etc.) via phone at
(909) 623-6131.
Cory Raymond Sullivan is licensed to practice in California (license number 113818) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1275069577.
Healthcare Provider's Profile
| Full Name | Cory Raymond Sullivan |
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| Gender | Male |
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| Speciality | Social Worker - Clinical |
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| Location | 2008 N Garey Ave, Pomona, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1275069577
- Provider Enumeration Date: 05/04/2017
- Last Update Date: 07/05/2023
Medicare PECOS Information:
- PECOS PAC ID: 4587029418
- Enrollment ID: I20230428001526
Medical Identifiers
Medical identifiers for Cory Raymond Sullivan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1275069577 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | ASW84456 (California) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (California) | Secondary |
| 1041C0700X | Social Worker - Clinical | 113818 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Cory Raymond Sullivan allows following entities to bill medicare on his behalf.
| Entity Name | Grow Healthcare Group Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1154994846
PECOS PAC ID: 1850774746
Enrollment ID: O20220809004080 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Cory Raymond Sullivan is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Cory Raymond Sullivan, ASW
2008 N Garey Ave,
Pomona, CA 91767-2722
Ph: (909) 623-6131 | Cory Raymond Sullivan, ASW
2008 N Garey Ave,
Pomona, CA 91767-2722
Ph: (909) 623-6131 |
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