MICHAEL KEVIN SULLIVAN – Mental Health Counselor, NPI 1336808179

MICHAEL KEVIN SULLIVAN is a healthcare provider. based in Jacksonville, Florida. specializing in MENTAL HEALTH COUNSELOR. The NPI Number for MICHAEL KEVIN SULLIVAN is 1336808179

Main info

Male
5 Years Of Experience
Accepts Medicare Assignment
Name
MICHAEL KEVIN SULLIVAN
NPI
1336808179
Phone
Not provided
Address
3027 SAN DIEGO RD FL 32207
Enumeration Date
9 December 2021
Last Update Date
9 December 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7325808383
Graduation Year
2021 (5 years ago)
PAC ID
7719403666
Group Practice PAC ID
5890952998
Professional Enrollment ID
I20250424000519
Address ID
FL330674638CO5421XDRXX401
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:4State licenses:0Digital endpointsOther names

3,020 MENTAL HEALTH COUNSELOR in FL

Provider Addresses for MICHAEL KEVIN SULLIVAN

  • 3027 SAN DIEGO RD FL 32207

    JACKSONVILLE, FL 322073691

    Phone:

    Type: Mailing

  • 3027 SAN DIEGO RD

    JACKSONVILLE, FL 322073691

    Phone: (904) 493-7744

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2025-04-24

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250424000519IMental Health CounselorFLTBD

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.

Verify on CMS Revalidation Lookup Tool

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 32207)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5890952998View full group profile
NameSpecialtyState
Clinical Social WorkerFL
Clinical Social WorkerFL
-PA
Clinical Social WorkerFL
Clinical Social WorkerNY
-NY
Clinical Social WorkerFL
Clinical Social WorkerPA
-FL
Clinical Social WorkerCT

Reviews

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Frequently asked questions

Is MICHAEL KEVIN SULLIVAN listed with a National Provider Identifier?
Yes — MICHAEL KEVIN SULLIVAN has NPI 1336808179 on file in the registry.
Would MICHAEL KEVIN SULLIVAN appear as active to a payer?
You can treat MICHAEL KEVIN SULLIVAN as active for directory purposes; confirm clinical privileges separately.
What expertise is attributed to MICHAEL KEVIN SULLIVAN?
MICHAEL KEVIN SULLIVAN's specialty line reads Mental Health Counselor. Clinical services aligned with this taxonomy classification.
Where in Florida is MICHAEL KEVIN SULLIVAN registered?
Use Jacksonville, Florida as the headline location for MICHAEL KEVIN SULLIVAN here.
When was this NPI issued?
Enumeration for MICHAEL KEVIN SULLIVAN is noted as December 9, 2021 where the registry provides it.

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