SONNY SULLIVAN (PA-C) – Physician Assistant, NPI 1215610779

SONNY SULLIVAN (PA-C) is a healthcare provider. based in Mt pleasant, Michigan. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. 5601011968 (MI). The NPI Number for SONNY SULLIVAN (PA-C) is 1215610779

Main info

Male
Sole Proprietor
3 Years Of Experience
Accepts Medicare Assignment
Name
SONNY SULLIVAN (PA-C)
NPI
1215610779
Phone
(989) 854-2266
Address
1970 Ashland Dr
Enumeration Date
10 August 2023
Last Update Date
14 April 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5862632300
Graduation Year
2023 (3 years ago)
PAC ID
5698122240
Group Practice PAC ID
7911808381
Professional Enrollment ID
I20231103002366
Address ID
MI480383504CL15855RDXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience33
Completeness75
Years active:2State licenses:1Digital endpointsOther names

6,066 PHYSICIAN ASSISTANT in MI

Provider Addresses for SONNY SULLIVAN (PA-C)

  • 1970 Ashland Dr

    MT Pleasant, MI 488581203

    Phone: (989) 854-2266

    Type: Location

  • 400 Hobart St

    Cadillac, MI 496012331

    Phone: (231) 876-7200

    Type: Location

  • 5838 S MISSION RD

    MT PLEASANT, MI 488585531

    Phone: (989) 854-2266

    Type: Mailing

  • 15855 19 MILE RD

    CLINTON TWP, MI 480383504

    Phone: (800) 532-2411

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 11 Open Payments records for all available years, with a total value of $686.

Total Amount is formed as General ($686) + Research ($0) + Ownership ($0) = $686.

Last reported payment date: 2024-07-23 • Largest payer in this snapshot: Intuitive Surgical, Inc. ($561).

Total Amount

$686

General + Research + Ownership

Payments

11

Total payment records

General Amount

$686

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-07-23

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2023-11-03

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
I20231103002366IPhysician AssistantMITBD

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 48858)

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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: 7911808381View full group profile
NameSpecialtyState
Family PracticeMI
-MI
Nurse PractitionerMI
Nurse PractitionerMI
Certified Registered Nurse Anesthetist (Crna)MI
Pediatric Medicine, Allergy/ImmunologyMI
Certified Registered Nurse Anesthetist (Crna)MI
Physician AssistantMI
Family PracticeMI
Nurse PractitionerMI

Reviews

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Frequently asked questions

What number should I use to identify SONNY SULLIVAN (PA-C) for billing?
Administrative and clinical systems typically use NPI 1215610779 for SONNY SULLIVAN (PA-C).
Is SONNY SULLIVAN (PA-C) currently accepting referrals based on NPI status?
Registry metadata lists SONNY SULLIVAN (PA-C) as active.
What services align with SONNY SULLIVAN (PA-C)'s listing?
SONNY SULLIVAN (PA-C)'s public classification highlights Physician Assistant. Clinical services aligned with this taxonomy classification.
What city is tied to SONNY SULLIVAN (PA-C)?
The directory associates SONNY SULLIVAN (PA-C) with Mt Pleasant, Michigan. Check all listed addresses for suites or satellite offices.
Who maintains SONNY SULLIVAN (PA-C)'s record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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