Dr. Tim Sullivan , MD
Pediatrics • Sonora, CA
Notice of NPI Deactivation & Inactive Practice Status
According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Tim Sullivan has officially deactivated this NPI record and ceased active healthcare practice.
Professional Overview & Biography Verified Profile Summary
Dr. Tim Sullivan, MD was a registered Pediatrics practicing in Sonora, CA. Throughout an active medical career spanning 13 years, Dr. Sullivan provided care at the practice location at 12791 CABEZUT RD until profile deactivation on 2019-07-12.
Practice Location & Contact Primary Location
12791 Cabezut Rd
Sonora, CA 953705926
Specialty Benchmarks & Practice Insights
Comparative analytics for Pediatrics in Sonora, CA
Practicing in Sonora, CA (9612 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Medical Specialties & State Licenses
NUCC Taxonomy Code: 208000000X
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
NUCC Taxonomy Code: 208000000X
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Practice Associates & Co-Workers
Healthcare professionals and specialists practicing at this location or sharing practice phone/fax
Pediatrics
Doctor of Medicine (M.D.)
Family Medicine
Doctor of Osteopathic Medicine (D.O.)
Pediatrics
Doctor of Medicine (M.D.)
Pediatrics
Doctor of Medicine (M.D.)
Internal Medicine - Rheumatology
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
Record officially reactivated for active practice on July 29, 2019
Registered at 12791 CABEZUT RD, SONORA, CA 953705926 (Tel: 2095325524)
Registered at 12791 CABEZUT RD, SONORA, CA 953705926 (Tel: 2095325524)
Pediatrics (License #C55917 in CA)
Record deactivated on July 12, 2019
NPI status registered as active in NPPES database
Registered at 205 NW R D MIZE RD, SUITE 304, BLUE SPRINGS, MO 64014 (Tel: 8162284770)
Registered at 205 NW R D MIZE RD, SUITE 304, BLUE SPRINGS, MO 64014 (Tel: 8162284770)
Recorded as TIM SULLIVAN, MD
Pediatrics (License #2007010305 in MO)
First registered as active Individual Practitioner in NPPES Database.
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NPI Administrative Meta
Mailing Address
12791 Cabezut Rd
Sonora, CA 953705926
Phone: 2095325524
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