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BRETT MICHAEL SULLIVAN D.M.D., M.D.
NPI 1629268966
Dentist - Oral and Maxillofacial Surgery in Clackamas, OR

Active since August 01, 2007Opted out of Medicare · through Aug 29, 2027
11211 SE SUNNYSIDE RD, CLACKAMAS, OR 97015(503) 652-8080(503) 526-8992 Get Directions Write a Review

NPPES record last updated: December 6, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 6, 2024, Jun 8, 2021 (2 updates tracked since 2021).

About Brett Michael Sullivan D.m.d., M.d. NPPES

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

BRETT MICHAEL SULLIVAN D.M.D., M.D. (NPI 1629268966) is an individual oral and maxillofacial surgery provider in Clackamas, Oregon, licensed in Oregon (D9737) and active in the NPI registry since August 2007. He has opted out of Medicare through August 29, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1629268966
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameBRETT MICHAEL SULLIVANCredential: D.M.D., M.D.
Location Address11211 SE SUNNYSIDE RDClackamas, OR 97015-7787
Mailing Address11211 Se Sunnyside RdClackamas, OR 97015-7787 · (503) 652-8080 · Fax (503) 289-9621
Phone(503) 652-8080
Fax(503) 526-8992
Sole ProprietorYes
Enumeration DateAugust 1, 2007
Last NPPES UpdateDecember 6, 20242 updates tracked since enumeration
NPPES CertifiedDecember 6, 2024
✔ NPI 1629268966 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in OR · D9737
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Also ListedDentistTaxonomy 122300000X · License 2007019263 (MO)
11211 SE SUNNYSIDE RD, Clackamas, OR 97015
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Brett Michael Sullivan D.m.d., M.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from August 29, 2019 through August 29, 2027.

Opt-Out Effective DateAugust 29, 2019
Opt-Out In Effect ThroughAugust 29, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97015 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.51 typical visit price
range $58.99 – $176.88
Typical copayment $22.62 (range $14.74 – $44.22)
Most-billed visit code 99203
Established Patient
$73.28 typical visit price
range $19.32 – $144.79
Typical copayment $18.32 (range $4.83 – $36.19)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LARRY L MOFFETT DO
Family Medicine
11211 SE SUNNYSIDE RD
CLACKAMAS, OR 97015
Clackamas County (503) 659-0880
JENNIFER ANDRESON A.R.N.P
Nurse Practitioner (Family)
11211 SE SUNNYSIDE RD
CLACKAMAS, OR 97015
Clackamas County (503) 659-0880
LESLIE NICOLE CLEMENTS LCSW
Social Worker (Clinical)
11211 SE SUNNYSIDE RD
CLACKAMAS, OR 97015
Clackamas County (503) 740-1971

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 Brett Sullivan's NPI number?

The NPI number for Brett Sullivan is 1629268966. It was assigned to this individual provider in the NPPES registry on August 1, 2007.

Where is Brett Sullivan located?

Brett Sullivan practices at 11211 SE Sunnyside Rd, Clackamas, OR 97015. The listed phone number is (503) 652-8080.

What is Brett Sullivan's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Brett Sullivan enrolled in Medicare?

No. Brett Sullivan has opted out of Medicare through August 29, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Brett Sullivan was last updated on December 6, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months 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.