Dr Lisa C Sullivan, MD is a medicare enrolled "Pediatrics" physician in Milwaukie, Oregon. Her current practice location is
4950 Se Roethe Rd, Milwaukie, Oregon. You can reach out to her office (for appointments etc.) via phone at
(503) 722-6858.
Dr Lisa C Sullivan is licensed to practice in Oregon (license number MD24619) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1841380375.
Physician's Profile
| Full Name | Dr Lisa C Sullivan |
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| Gender | Female |
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| Speciality | Pediatrics |
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| Location | 4950 Se Roethe Rd, Milwaukie, Oregon |
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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: 1841380375
- Provider Enumeration Date: 10/13/2006
- Last Update Date: 06/27/2019
Medicare PECOS Information:
- PECOS PAC ID: 1658463245
- Enrollment ID: I20070828000310
Medical Identifiers
Medical identifiers for Dr Lisa C Sullivan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1841380375 | NPI | - | NPPES |
| 096511 | Medicaid | OR | |
| 240558 | Medicaid | OR | |
| 22959 | Medicaid | OR | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208000000X | Pediatrics | MD24619 (Oregon) | 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. Dr Lisa C Sullivan allows following entities to bill medicare on her behalf.
| Entity Name | Multnomah County |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1609914787
PECOS PAC ID: 6608771787
Enrollment ID: O20031203000025 |
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| Entity Name | Clackamas County |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1841443587
PECOS PAC ID: 9537065560
Enrollment ID: O20031210000827 |
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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. Dr Lisa C 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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Dr Lisa C Sullivan, MD
421 Sw Oak St, Ste 210,
Portland, OR 97204-1817
Ph: (503) 988-7468 | Dr Lisa C Sullivan, MD
4950 Se Roethe Rd,
Milwaukie, OR 97267-5746
Ph: (503) 722-6858 |
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