KEITH EDWARD SULLIVAN DPT
NPI 1164823738
Physical Therapist - Orthopedic in San Bruno, CA
About Keith Edward Sullivan Dpt NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KEITH EDWARD SULLIVAN DPT (NPI 1164823738) is an individual orthopedic provider in San Bruno, California, licensed in California (37244) and active in the NPI registry since September 2014.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Keith Edward Sullivan Dpt is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Keith Sullivan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
San Francisco, CA 94116
- Reassigned Medicare billing, California enrollment
- 20,078 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SAN BRUNO, CA 94066
SAN BRUNO, CA 94066
SAN BRUNO, CA 94066
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 Keith Sullivan's NPI number?
The NPI number for Keith Sullivan is 1164823738. It was assigned to this individual provider in the NPPES registry on September 15, 2014.
Where is Keith Sullivan located?
Keith Sullivan practices at 1001 Sneath Ln, San Bruno, CA 94066. The listed phone number is (650) 871-8645.
What is Keith Sullivan's specialty?
The primary specialty registered for this NPI is Physical Therapist, specializing in Orthopedic, with taxonomy code 2251X0800X.
Is Keith Sullivan enrolled in Medicare?
Yes. Keith Sullivan is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Keith Sullivan's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Keith Sullivan reassigns Medicare benefits to Permanente Medical Group Inc (San Francisco, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Keith Sullivan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Keith Sullivan was last updated on January 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Keith Edward Sullivan, DPT · NPI 1164823738
Orthopedic provider in San Bruno, California. Individual provider, active in the CMS NPPES registry since September 15, 2014.
## Identity
- **NPI:** 1164823738 (Entity type: Individual)
- **Enumerated:** September 15, 2014
- **Primary specialty:** Physical Therapist - Orthopedic · taxonomy 2251X0800X
- **State license:** 37244 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 1001 SNEATH LN, San Bruno, CA 94066-2308
- **Phone:** (650) 871-8645
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** Permanente Medical Group Inc (NPI 1841373800, San Francisco, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 3, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1164823738) · Data from the CMS NPPES public registry.