Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1730775495 Individual Practitioner Male Practitioner

Samuel Sullivan

Licensed Practical Nurse • Salem, OR

Professional Overview & Biography Verified Profile Summary

Samuel Sullivan is a registered healthcare professional specializing in Licensed Practical Nurse in Salem, OR. Practice services are available at 1750 MCGILCHRIST ST SE STE 130 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1750 Mcgilchrist St Se Ste 130

Salem, OR 973021691

Telephone 9713042200

Specialty Benchmarks & Practice Insights

Comparative analytics for Licensed Practical Nurse in Salem, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
72 Specialists

Practicing in Salem, OR (741 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2020-12-16
Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

State License OR 202007792LPN

An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

10 Associated Practitioners
Kristie Brock , PTA

Physical Medicine & Rehabilitation

NPI 1033762240

Physical Therapist Assistant

Jordan Skoubo , RD, MPH, CPH

Dietitian, Registered

NPI 1164121075

Registered Dietitian, Master of Public Health, CPH

Dr. John Walters , MD

Family Medicine

NPI 1164405783

Doctor of Medicine (M.D.)

NPI 1174252761

Doctor of Optometry

Dr. Annie Reynolds , DNP

Nurse Practitioner - Family

NPI 1285205880

Doctor of Nursing Practice

Adelheid Allen

Registered Nurse

NPI 1356286710

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active December 16, 2020

NPI status registered as active in NPPES database

📍
Updated Practice Location December 16, 2020

Registered at 1750 MCGILCHRIST ST SE STE 130, SALEM, OR 973021691 (Tel: 9713042200)

📍
Updated Business Mailing Address December 16, 2020

Registered at 1332 LYDIA AVE N, KEIZER, OR 973037550 (Tel: 5168607294)

👤
Provider Name / Credentials Updated December 16, 2020

Recorded as SAMUEL SULLIVAN

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) December 16, 2020

Licensed Practical Nurse (License #202007792LPN in OR)

🟢
Initial NPI Registration & Enumeration December 16, 2020

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1730775495
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 16, 2020
Last Update: December 16, 2020
Sole Proprietor: No

Mailing Address

1332 Lydia Ave N

Keizer, OR 973037550

Phone: 5168607294

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.