Mr Kenneth W Sullivan, MD is a medicare enrolled "Family Medicine" physician in Joelton, Tennessee. He went to Louisiana State University School Of Medicine In Shreveport and graduated in 1979 and has 45 years of diverse experience with area of expertise as Family Practice. His current practice location is
3511 Old Clarksville Pike, Joelton, Tennessee. You can reach out to his office (for appointments etc.) via phone at
(615) 299-5341.
Mr Kenneth W Sullivan is licensed to practice in Tennessee (license number 27509) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1376637215.
Physician's Profile
| Full Name | Mr Kenneth W Sullivan |
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| Gender | Male |
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| Speciality | Family Practice |
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| Experience | 45 Years |
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| Location | 3511 Old Clarksville Pike, Joelton, Tennessee |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mr Kenneth W Sullivan attended and graduated from Louisiana State University School Of Medicine In Shreveport in 1979
NPI Data:
- NPI Number: 1376637215
- Provider Enumeration Date: 10/03/2006
- Last Update Date: 06/09/2015
Medicare PECOS Information:
- PECOS PAC ID: 5597797191
- Enrollment ID: I20050902000719
Medical Identifiers
Medical identifiers for Mr Kenneth W Sullivan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1376637215 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 27509 (Tennessee) | 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. Mr Kenneth W Sullivan allows following entities to bill medicare on his behalf.
| Entity Name | Pain Management Group, P.c. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1902804271
PECOS PAC ID: 7012812043
Enrollment ID: O20080530000028 |
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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. Mr Kenneth W 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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Mr Kenneth W Sullivan, MD
Po Box 57,
Springfield, TN 37172-0057
Ph: (615) 299-5341 | Mr Kenneth W Sullivan, MD
3511 Old Clarksville Pike,
Joelton, TN 37080-8892
Ph: (615) 299-5341 |
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