Dr Bernard Harrell Sullivan Jr, PHD is a medicare enrolled "Psychologist - Clinical" provider in Dallas, North Carolina. His current practice location is
203 N Hoffman St, Dallas, North Carolina. You can reach out to his office (for appointments etc.) via phone at
(704) 813-4033.
Dr Bernard Harrell Sullivan Jr is licensed to practice in North Carolina (license number 102806) 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 1326282633.
Healthcare Provider's Profile
| Full Name | Dr Bernard Harrell Sullivan Jr |
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| Gender | Male |
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| Speciality | Psychologist - Clinical |
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| Location | 203 N Hoffman St, Dallas, North Carolina |
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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: 1326282633
- Provider Enumeration Date: 04/30/2009
- Last Update Date: 01/14/2019
Medicare PECOS Information:
- PECOS PAC ID: 8527201755
- Enrollment ID: I20130906000642
Medical Identifiers
Medical identifiers for Dr Bernard Harrell Sullivan Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1326282633 | NPI | - | NPPES |
| 1817W | Other | NC | BCBS NC |
| 6001164 | Medicaid | NC | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TC0700X | Psychologist - Clinical | 102806 (North Carolina) | 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 Bernard Harrell Sullivan Jr allows following entities to bill medicare on his behalf.
| Entity Name | Onsite Care Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1912338328
PECOS PAC ID: 7012149222
Enrollment ID: O20140422000656 |
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| Entity Name | Vaughters Specialized Consultative Services Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1851705446
PECOS PAC ID: 1052694890
Enrollment ID: O20210106001712 |
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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 Bernard Harrell Sullivan Jr 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 |
|---|
Dr Bernard Harrell Sullivan Jr, PHD
203 N Hoffman St,
Dallas, NC 28034-1525
Ph: (704) 813-4033 | Dr Bernard Harrell Sullivan Jr, PHD
203 N Hoffman St,
Dallas, NC 28034-1525
Ph: (704) 813-4033 |
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