Ryan A Sullivan (NPI# 1174605653, PAC ID# 0547292294) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERNAL MEDICINE.
| Nation Provider ID (NPI) | 1174605653 |
| PAC ID by PECOS | 0547292294 |
| Professional Enrollment ID | I20050906000090 |
| Full Name | Ryan A Sullivan |
| Organization Legal Name | CRYSTAL LAKE CLINIC PC |
| Address |
8225 Lake St Bear Lake MI 49614-9612 |
| Phone Number | 2318643314 |
| Gender | M |
| Credential | MD |
| Medical School | WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 2002 |
| Primary Specialty | INTERNAL MEDICINE |
| Group Practice PAC ID | 0648259010 |
| Number of Group Practice Members | 36 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 230303 | MUNSON HEALTHCARE MANISTEE HOSPITAL |
| 230110 | SPECTRUM HEALTH LUDINGTON HOSPITAL |
| 231300 | PAUL OLIVER MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 8225 Lake St, Bear Lake, MI 49614-9612 | 2318643314 | CRYSTAL LAKE CLINIC PC |
| 2198 Us Hwy 31 S, Manistee, MI 49660-9618 | 2317233567 | CRYSTAL LAKE CLINIC PC |
| Organization Legal Name | CRYSTAL LAKE CLINIC PC |
| Physicians | 42 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Becky Lynn Porter | Nurse Practitioner | Crystal Lake Clinic PC | 115 E 7th St, Manton, MI 49663-9429 |
| Danielle Koch | Nurse Practitioner | Crystal Lake Clinic PC | 6170 Us Hwy 31 N, Williamsburg, MI 49690-9306 |
| Emily L Fader | Physician Assistant | Crystal Lake Clinic PC | 6227 Frankfort Hwy, Benzonia, MI 49616-8632 |
| Karen Lynn Volas | Nurse Practitioner | Crystal Lake Clinic PC | 1975 Stirling Dr, Interlochen, MI 49643-9264 |
| George B Ryckman | Family Medicine | Crystal Lake Clinic PC | 8225 Lake St, Bear Lake, MI 49614-9612 |
| Michael F Carroll | Family Medicine | Crystal Lake Clinic PC | 2283 E M, Suite 113, Kingsley, MI 49649-9370 |
| Maureen Street | Family Medicine | Crystal Lake Clinic PC | 124 Ames St, Elk Rapids, MI 49629-9449 |
| Tracy Robinson | Nurse Practitioner | Crystal Lake Clinic PC | 8225 Lake St, Bear Lake, MI 49614-9612 |
| Jacob Flynn | Family Medicine | Crystal Lake Clinic PC | 6227 Frankfort Hwy, Benzonia, MI 49616-8632 |
| Michelle M Macdonald | Physician Assistant | Crystal Lake Clinic PC | 6227 Frankfort Hwy, Benzonia, MI 49616-8632 |
| Street Address |
8225 LAKE ST |
| City | BEAR LAKE |
| State | MI |
| Zip | 49614-9612 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| George B Ryckman | Family Medicine | Crystal Lake Clinic PC | 8225 Lake St, Bear Lake, MI 49614-9612 |
| Tracy Robinson | Nurse Practitioner | Crystal Lake Clinic PC | 8225 Lake St, Bear Lake, MI 49614-9612 |
| Roberta L Herbst | Physician Assistant | Crystal Lake Clinic PC | 8225 Lake St, Bear Lake, MI 49614-9612 |
| Maryann Marie Smith | Physician Assistant | Crystal Lake Clinic PC | 8225 Lake St, Bear Lake, MI 49614-9612 |
| Geoffrey Turner | Internal Medicine | Crystal Lake Clinic PC | 8225 Lake St, Bear Lake, MI 49614-9612 |
| Glenn Griffiths | Family Medicine | Crystal Lake Clinic PC | 8225 Lake St, Bear Lake, MI 49614-9612 |
| Christina Bookheimer | Nurse Practitioner | Crystal Lake Clinic PC | 8225 Lake St, Bear Lake, MI 49614-9612 |
| City | BEAR LAKE |
| Zip Code | 49614 |
| Specialty | INTERNAL MEDICINE |
| City + Specialty | BEAR LAKE + INTERNAL MEDICINE |
Please comment or provide details below to improve the information on Ryan A Sullivan.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.