DR. RANDALL GENE SULLIVAN (MD) – Psychiatry Physician, NPI 1114942653
Psychiatry Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
202 PSYCHIATRY in ME
Provider Addresses for DR. RANDALL GENE SULLIVAN (MD)
25 June St
Sanford, ME 040732621
Phone: (207) 490-7000
Fax: (207) 490-7002
Type: Location
555 S Schwartz Ave
Farmington, NM 874015955
Phone: (505) 609-6680
Type: Location
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 681988102
Phone:
Type: Mailing
EMILE @ 42ND ST
OMAHA, NE 681985575
Phone: (402) 552-6007
Type: Location
Farmington Post Office, 113, Elm Street, Farmington, Dakota County, Minnesota, 55024, United States
FARMINGTON, NM 874996210
Phone: (505) 609-2258
Fax: (505) 609-2259
Type: Mailing
Great Plains Health, 601, West Leota Street, North Platte, Lincoln County, Nebraska, 69101, United States
NORTH PLATTE, NE 691016525
Phone: (308) 696-7251
Fax: (308) 696-7261
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: 2025-12-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20070208000259 | I | Psychiatry | NE | TBD |
| I20180514000805 | I | Psychiatry | NM | TBD |
| I20251212000764 | I | Psychiatry | ME | 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 04073)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PSYCHIATRY | NE | 90792 | Psychiatric diagnostic evaluation with medical services | 41 | 34 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | PA | |
| - | ME | |
| - | ME | |
| - | ME | |
| - | ME | |
| Family Practice, Hospice/Palliative Care | ME | |
| Pediatric Medicine, Endocrinology | MA | |
| - | ME | |
| Family Practice | ME | |
| Nurse Practitioner | ME |
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