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MR. RONIN ANTHONY SULLIVAN
NPI 1104408285
Student in an Organized Health Care Education/Training Program in Denver, CO

Active since April 27, 2021PECOS EnrolledAccepts Medicare Assignment
17858 E 54TH AVE, DENVER, CO 80249(850) 543-7434 Get Directions Write a Review

NPPES record last updated: April 27, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Ronin Anthony Sullivan NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. RONIN ANTHONY SULLIVAN (NPI 1104408285) is an individual student in an organized health care education/training program in Denver, Colorado and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1104408285
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMR. RONIN ANTHONY SULLIVAN
Location Address17858 E 54TH AVEDenver, CO 80249-8819
Mailing Address17858 E 54th AveDenver, CO 80249-8819 · (850) 543-7434
Phone(850) 543-7434
Sole ProprietorYes
Medical School CMSOtherGraduated 2022
Enumeration DateApril 27, 2021
NPPES CertifiedApril 27, 2021
✔ NPI 1104408285 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
17858 E 54TH AVE, Denver, CO 80249
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Ronin Anthony Sullivan is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6204316698
PECOS Enrollment IDI20260216000750
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ronin Sullivan's NPI number?

The NPI number for Ronin Sullivan is 1104408285. It was assigned to this individual provider in the NPPES registry on April 27, 2021.

Where is Ronin Sullivan located?

Ronin Sullivan practices at 17858 E 54th Ave, Denver, CO 80249. The listed phone number is (850) 543-7434.

What is Ronin Sullivan's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Ronin Sullivan enrolled in Medicare?

Yes. Ronin Sullivan is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Ronin Sullivan was last updated on April 27, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.