DONALD RICHARD SULLIVAN MD NPI 1003019621

Internal Medicine (Pulmonary Disease) in Portland, OR

NPI 1003019621 Individual Male Years of Experience 16 Internal Medicine Pulmonary Disease PECOS Enrolled Accepts Medicare Approved Payment MIPS Quality Score 90.9

NPI Profile for DONALD RICHARD SULLIVAN MD

Donald Sullivan is an internal medicine provider established in Portland, Oregon and his medical specialization is internal medicine (pulmonary disease) with more than 16 years of experience. He graduated from University Of Arizona College Of Medicine in 2007. The NPI number of Donald Sullivan is 1003019621 and was assigned on June 2007. The practitioner's primary taxonomy code is 207RP1001X with license number MD151732 (OR). The provider is registered as an individual and his NPI record was last updated 9 years ago.

An internist like Donald Richard Sullivan Md is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

Donald Sullivan is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

Donald Sullivan is registered with Medicare and accepts claims assignment, this means the provider accepts Medicare's approved amount for the cost of rendered services as full payment. Participating providers may not charge Medicare beneficiaries more than Medicare's approved amount for their services. Medicare beneficiaries still have to pay a coinsurance or copayment amount for a visit or service. According to Medicare claims data he has hospital affiliations with Ohsu Hospital And Clinics.

The provider participated in Medicare's Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 90.9, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance.

The typical physician office visit costs for Medicare beneficiaries in this area are: $34.53 for a new patient copayment and $26.82 for an established patient copayment.

NPI

1003019621

Provider Name DONALD RICHARD SULLIVAN MD
Provider Location Address3181 SW SAM JACKSON PARK RD UHN67 PORTLAND, OR 97239
Provider Mailing Address3181 SW SAM JACKSON PARK RD UHN67 PORTLAND, OR 97239
GenderMale
NPI Entity TypeIndividual
Medical School NameUNIVERSITY OF ARIZONA COLLEGE OF MEDICINE
Graduation Year2007
Is Sole Proprietor?Yes
Is Organization Subpart?N/A
Enumeration Date06-10-2007
Last Update Date10-31-2013


Primary Taxonomy

Taxonomy Code207RP1001X
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationPulmonary Disease
License No.MD151732
License StateOR
Taxonomy DescriptionAn internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs.

Business Address

DONALD RICHARD SULLIVAN MD
3181 SW SAM JACKSON PARK RD
UHN67
PORTLAND, OR
ZIP 97239
Phone: (503) 494-6949

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Mailing Address

DONALD RICHARD SULLIVAN MD
3181 SW SAM JACKSON PARK RD
UHN67
PORTLAND, OR
ZIP 97239
Phone: (503) 494-6949



PECOS Enrollment and Medicare Participation

What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare's enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.

Registered in PECOS? Yes
PECOS PAC ID7911152749
PECOS Enrollment IDI20131122001950
Accepts Medicare Assignment? Yes "What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
Eligible order / refer Part B Clinical Laboratory and ImagingYes
Eligible order / refer Durable Medical EquipmentYes
Eligible order / refer Home Health Agency (HHA)Yes
Eligible order / refer Power Mobility DevicesYes

Physician Office Visit Costs

The provider accepts as payment the Medicare approved amount. Medicare beneficiaries should not be billed for more than the Medicare deductible and coinsurance amounts. Medicare pricing is usually a reference point for private insurance covered patients. The prices below reflect the costs for new and established patients in the 97239 ZIP code area.

New Patients Office Visits Costs *
Most Utilized Procedure Code for new patients office visits: 99204
Minimum New Patient Pricing Maximum New Patient Pricing Typical New Patient Pricing
$60.52 $182.22 $138.14
Minimum New Patient Copayment Maximum New Patient Copayment Typical New Patient Copayment
$15.13 $45.55 $34.53
Established Patients Office Visits Costs *
Most Utilized Procedure Code for established patients office visits: 99214
Minimum Established Patient Pricing Maximum Established Patient Pricing Typical Established Patient Pricing
$19.23 $149.48 $107.31
Minimum Established Patient Copayment Maximum Established Patient Copayment Typical Established Patient Copayment
$4.8 $37.37 $26.82

* The physician office visit costs information is obtained by Medicare's statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Overall MIPS Quality Performance

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in Medicare's Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

MIPS Measure Score Weight Score
Quality 40% 100
The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.

There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.
Promoting Interoperability (PI) 25% 73
The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.

The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.
Improvement Activities 15% 40
The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs.

The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.
Cost 20% 68.2
The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.
MIPS Final Score - 90.9
The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.

Clinician Utilization

The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.

  • 42Measurement and graphic recording of total and timed exhaled air capacity (HCPCS:94010)
  • 23Measurement of lung diffusing capacity (HCPCS:94729)
  • 11Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration (HCPCS:94060)

Hospital Affiliations

Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Donald Sullivan is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN) Overall Rating
OHSU HOSPITAL AND CLINICS3181 SW SAM JACKSON PARK ROAD
PORTLAND, OR 97239
(503) 494-6245Acute Care Hospitals380009

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineMD151732ORNo

Taxonomy Description: a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

2207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineMD151732ORNo

Taxonomy Description: an internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists.

NPI Validation Check Digit Calculation


The following table explains step by step the NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1003019621
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2003011864
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 0 + 3 + 0 + 1 + 1 + 8 + 6 + 4 + 24 = 49
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 49 = 11

The NPI number 1003019621 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1972506301 JERRIS ROBERT HEDGES MD, MS, MMM
Individual
Emergency Medicine3181 SW SAM JACKSON PARK RD # L-102
PORTLAND, OR 97239
(503) 494-2767
1720082357DR. BRANDON ZANE HOROWITZ M.D.
Individual
Emergency Medicine3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
(503) 494-4833
1770587222 MARY ANN BROWNING FNP
Individual
Nurse Practitioner (Family)3181 SW SAM JACKSON PARK RD CDW-EM
PORTLAND, OR 97239
(503) 494-7500
1427052166DR. ROBERT AUGUSTUS LOWE MD, MPH
Individual
Emergency Medicine3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
(503) 494-7134
1629073895DR. MOHAMUD RAMZANALI DAYA MD, M S
Individual
Emergency Medicine3181 SW SAM JACKSON PARK RD MAILCODE CDW-EM
PORTLAND, OR 97239
(503) 494-7248
1720083991DR. RITU SAHNI MD
Individual
Emergency Medicine3181 SW SAM JACKSON PARK RD # CDW
PORTLAND, OR 97239
(503) 494-7500
1336144450DR. ALFREDO SABBAJ MD
Individual
Emergency Medicine3181 SW SAM JACKSON PARK RD MAIL CODE: CDW-EM
PORTLAND, OR 97239
(503) 494-1475
1467457192 ROBERT G HENDRICKSON MD
Individual
Emergency Medicine (Medical Toxicology)3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
(503) 494-9495
1912907908DR. JONATHAN JUI M.D.
Individual
Emergency Medicine3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
(503) 494-7500
1013918267DR. JAMES CHRISTOPHER AUSTIN MD
Individual
Urology (Pediatric Urology)3181 SW SAM JACKSON PARK RD PEDIATRIC UROLOGY CDW-6
PORTLAND, OR 97239
(503) 494-4808
1285626507 JENNIFER R ANTICK PHD
Individual
Psychologist (Clinical)3181 SW SAM JACKSON PARK RD UHN 80
PORTLAND, OR 97239
(503) 494-7353
1053304006 PAULA A VANDERFORD M.D.
Individual
Pediatrics (Pediatric Critical Care Medicine)3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
(503) 418-5800
1043206279MS. MICHELE PATRICIA MEGREGIAN CNM
Individual
Advanced Practice Midwife3181 SW SAM JACKSON PARK RD KPV7C
PORTLAND, OR 97239
(503) 418-4500
1285615781 SUSAN ROWELL M.D.
Individual
Surgery (Trauma Surgery)3181 SW SAM JACKSON PARK RD L611
PORTLAND, OR 97239
(503) 494-2400
1104809920 DAVID MARK SPIRO MD
Individual
Pediatrics (Pediatric Emergency Medicine)3181 SW SAM JACKSON PARK RD MAIL CODE CDW-EM
PORTLAND, OR 97239
(503) 494-0828
1457337123MR. PETER CHORDAS FNP-C
Individual
Nurse Practitioner3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
(503) 494-1368
1174509897DR. PASCALE M SCHWAB M.D.
Individual
Internal Medicine (Rheumatology)3181 SW SAM JACKSON PARK RD OP09
PORTLAND, OR 97239
(503) 494-8963
1356320089MS. CORI DELINN FEIST M.S.
Individual
Genetic Counselor, MS3181 SW SAM JACKSON PARK RD MAILCODE: PPV420
PORTLAND, OR 97239
(503) 418-4207
1104896786DR. STEVEN JOHN SKOOG
Individual
Urology (Pediatric Urology)3181 SW SAM JACKSON PARK RD CDW6
PORTLAND, OR 97239
(503) 494-4808
1760456925DR. CRAIGAN TODD USHER MD
Individual
Psychiatry & Neurology (Psychiatry)3181 SW SAM JACKSON PARK RD MAIL CODE DC7P
PORTLAND, OR 97239
(503) 418-5775

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
Donald Richard Sullivan Md is registered as an entity type code: 1. The entity type code describes the type of health care provider that is being assigned an NPI. The entity type codes are:

  • 1 = Person: individual human being who furnishes health care.
  • 2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.