Mack Lee Sullivan, MD is a medicare enrolled "Emergency Medicine" physician in Tuckahoe, New York. He went to Albert Einstein College Of Medicine Of Yeshiva University and graduated in 1995 and has 29 years of diverse experience with area of expertise as Internal Medicine. His current practice location is
150 Lake Ave, Tuckahoe, New York. You can reach out to his office (for appointments etc.) via phone at
(914) 395-3691.
Mack Lee Sullivan is licensed to practice in New York (license number 203477-1) and he also participates in the medicare program. He
may accept medicare assignments (which means he may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and his NPI Number is 1881616068.
Physician's Profile
| Full Name | Mack Lee Sullivan |
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| Gender | Male |
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| Speciality | Internal Medicine |
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| Experience | 29 Years |
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| Location | 150 Lake Ave, Tuckahoe, New York |
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| Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mack Lee Sullivan attended and graduated from Albert Einstein College Of Medicine Of Yeshiva University in 1995
NPI Data:
- NPI Number: 1881616068
- Provider Enumeration Date: 07/24/2006
- Last Update Date: 08/24/2015
Medicare PECOS Information:
- PECOS PAC ID: 5698764314
- Enrollment ID: I20040508000152
Medical Identifiers
Medical identifiers for Mack Lee Sullivan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1881616068 | NPI | - | NPPES |
| 5C5609 | Other | NY | HEALTHNET |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207P00000X | Emergency Medicine | 203477-1 (New York) | Primary |
| 208100000X | Physical Medicine & Rehabilitation | 203477 (New York) | Secondary |
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. Mack Lee Sullivan allows following entities to bill medicare on his behalf.
| Entity Name | Fitness & Recovery Medical Practice, Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1114164225
PECOS PAC ID: 3870639990
Enrollment ID: O20091003000025 |
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| Entity Name | 369 Medical Practice Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1376141325
PECOS PAC ID: 5496155376
Enrollment ID: O20210615000800 |
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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. Mack Lee 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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Mack Lee Sullivan, MD
369 White Plains Rd,
Eastchester, NY 10709-2805
Ph: (914) 395-3691 | Mack Lee Sullivan, MD
150 Lake Ave,
Tuckahoe, NY 10707-3306
Ph: (914) 395-3691 |
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