SCOTT G SULLIVAN (PA) – Physician Assistant, NPI 1750440004
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,201 PHYSICIAN ASSISTANT in AL
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Provider Addresses for SCOTT G SULLIVAN (PA)
Lyster Army Health Clinic, 301, Andrews Avenue, Dale County, Alabama, 36362, United States
(LYSTER ARMY HEALTH CLINIC)
FORT RUCKER, AL 363625000
Phone: (334) 255-7097
Type: Location
408 W 19TH ST
PANAMA CITY, FL 324054602
Phone: (850) 481-1101
Type: Mailing
1901, McGinnis Court, Harker Heights, Bell County, Texas, 76548, United States
HARKER HEIGHTS, TX 765488034
Phone: (254) 698-2499
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 48 Open Payments records for all available years, with a total value of $757.
Total Amount is formed as General ($757) + Research ($0) + Ownership ($0) = $757.
Last reported payment date: 2024-11-04 • Largest payer in this snapshot: Novo Nordisk Inc ($193).
Total Amount
$757
General + Research + Ownership
Payments
48
Total payment records
General Amount
$757
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-04
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novo Nordisk Inc | $193 |
| Lilly USA, LLC | $111 |
| Mylan Specialty L.P. | $97 |
| Amgen Inc. | $63 |
| AstraZeneca Pharmaceuticals LP | $36 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-11-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20221111000756 | I | Physician Assistant | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 36362)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | FL | |
| Nurse Practitioner | FL | |
| - | FL | |
| Nurse Practitioner | MT | |
| Nurse Practitioner | FL | |
| Family Practice | FL | |
| Nurse Practitioner | FL | |
| - | MS |
Reviews
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