CLARENCE MICHAEL SULLIVAN (NPI# 1437756574) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437756574 |
| Entity Type | Individual |
| Full Name | CLARENCE MICHAEL SULLIVAN |
| Credential | IDMT |
| Practice Address |
3551 Roger Brooke Dr Fort Sam Houston TX 78234-4504 |
| Practice Telephone | 2109163918 |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-10-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
3551 ROGER BROOKE DR |
| City | FORT SAM HOUSTON |
| State | TX |
| Zip Code | 78234-4504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861093338 | Aneesh N/a Benoy | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-11-02 |
| 1164021580 | William Edward Vick | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-19 |
| 1548868003 | Julia D Coffey | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-15 |
| 1801493465 | Emiri Elliott | Registered Nurse | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-10-07 |
| 1093320350 | Natalie Marie Greene | Physical Therapist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-09-14 |
| 1033722509 | Kody Vallejo | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-25 |
| 1558972620 | Renee Therese Hart | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-12 |
| 1235749722 | Emily Ann Robinson | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-08-09 |
| 1902415367 | Hannah Daniel | Pharmacist | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-07-30 |
| 1972111052 | June Struder | Nurse Practitioner | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2020-07-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255942884 | Thomas Ballas | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Drive Jbsa-fort Sam Houston, Department of Behavioral Medicine-mche-dbm, San Antonio, TX 78234 | 2020-08-17 |
| 1124657366 | Wendy Harris | Pharmacist | 3041 Garden Ave, Fort Sam Houston, TX 78234 | 2020-04-08 |
| 1215564729 | Travis Frantz | Student in an Organized Health Care Education/Training Program | 3551 Rodger Brooke Drive, Jbsa Fort Sam Houston, TX 78234 | 2020-03-25 |
| 1508492695 | Matthew Grossmann | Student in an Organized Health Care Education/Training Program | San Antonio Military Medical Center, Mche-zdm-m, Internal Medicine Residency, 3551 Roger Brooke Dr., Jbsa-fort Sam Houston, TX 78234 | 2020-03-20 |
| 1235793407 | Jessica Maria May Franklin | Student in an Organized Health Care Education/Training Program | 3551 Roger Brooke Drive Jbsa Fort Sam Houston, San Antonio, TX 78234 | 2019-04-23 |
| 1730663477 | Glen Snyder | Military Health Care Provider | 3488 Garden Ave Anderson Hall, Fort Sam Houston, San Antonio, TX 78234 | 2018-09-19 |
| 1265919336 | Ashley Elizabeth Malawey | Military Health Care Provider | 3222 Cpl Johnson Road, San Antonio, TX 78234 | 2018-07-23 |
| 1053805515 | Rene Espinosa | Social Worker | San Antonio Medical Center, 3551 Roger Brooke Dr, Jbsa, TX 78234 | 2018-06-19 |
| 1235622333 | Melanie Edith Rivera | Military Health Care Provider | 3600 Roger Brooke Drive, San Antonio, TX 78234 | 2018-06-13 |
| 1063909158 | Benjamin Walker Appelo | General Practice | San Antonio Mil Med Center 3551 Roger Brooke Dr, Mche-zdm-m, San Antonio, TX 78234 | 2018-04-16 |
| Find all providers in zip 78234 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790382844 | Kyle Schachsieck | Military Health Care Provider | 2800 Winfield Scott Rd Ste 347, Fort Sam Houston, TX 78234-7662 | 2020-10-01 |
| 1154814382 | Nicolas Kepa Bell | Military Health Care Provider | 2800 Winfield Scott Rd, Fort Sam Houston, TX 78234-7662 | 2018-06-12 |
| 1467936104 | Heather Brown | Military Health Care Provider | 3488 Garden Ave, Anderson Hall Mif 4, Fort Sam Houston, TX 78234 | 2018-09-19 |
| 1457835191 | Erricka Smith | Military Health Care Provider | 3488 Garden Ave, Andersen Hall Mif-4, Fort Sam Houston, TX 78234-8898 | 2018-09-19 |
| 1790278927 | Drew Bivens | Military Health Care Provider | 2800 Winfield Scott Rd, Fort Sam Houston, TX 78234-7662 | 2018-06-12 |
| 1760970115 | Alyssa Simon | Military Health Care Provider | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2018-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407453145 | Ian Frogley | Military Health Care Provider | Jbsa 2230 Hughes Ave, San Antonio, TX 78236-8404 | 2020-10-06 |
| 1861099939 | Andrew Goebel | Military Health Care Provider | 1800 Truemper St, San Antonio, TX 78236-5510 | 2020-10-02 |
| 1861018178 | John C Gallik | Military Health Care Provider | 3176 Corporal Johnson Road, Jbsa Fort Sam Houston, TX 33809 | 2020-06-23 |
| 1376169086 | Colton Wayne Dickens | Military Health Care Provider | 5415 N Foster Rd Apt 8306, San Antonio, TX 78244-2405 | 2020-06-18 |
| 1750924692 | Michelle Lynn Hernando | Military Health Care Provider | 109 Kentucky St, Dyess Afb, TX 79607-1007 | 2019-10-23 |
| 1598315061 | Matthew Scott Floores | Military Health Care Provider | 7303 S Ute Trl, Austin, TX 78729-7756 | 2019-09-17 |
| 1427529650 | Riley Pearl Solomon | Military Health Care Provider | 6419 N Vandiver Rd Apt 2203, Alamo Heights, TX 78209-4484 | 2018-12-16 |
| 1588135719 | Alejandro Daniel Perez | Military Health Care Provider | Wilderness Trl & Camp Bullis, San Antonio, TX 78257 | 2018-12-16 |
| 1861969271 | Jose A Sanchez | Military Health Care Provider | 15425 Bobwhite Quail, San Antonio, TX 78253-6621 | 2018-10-24 |
| 1205303617 | Sean Patrick Kearns | Military Health Care Provider | 1980 Horal St Apt 1218, San Antonio, TX 78227-3939 | 2018-10-24 |
| Find all providers with the same taxonomy | ||||
| City | FORT SAM HOUSTON |
| Zip Code | 78234 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.