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ELISSA KIM SULLIVAN MD
NPI 1790216422
Pediatrics in San Ysidro, CA

Active since March 24, 2017PECOS Enrolled
4050 BEYER BLVD, SAN YSIDRO, CA 92173(619) 662-4100 Get Directions Write a Review

NPPES record last updated: August 11, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 11, 2020, Mar 24, 2017 (2 updates tracked since 2017).

About Elissa Kim Sullivan Md NPPES

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

ELISSA KIM SULLIVAN MD (NPI 1790216422) is an individual pediatrics provider in San Ysidro, California, licensed in California (169577) and active in the NPI registry since March 2017. She is enrolled in Medicare PECOS and maintains a secondary practice location in Aurora.

NPPES Registry Identity

NPI1790216422
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameELISSA KIM SULLIVANCredential: MD
Location Address4050 BEYER BLVDSan Ysidro, CA 92173-2007
Mailing Address1601 Precision Park LnSan Diego, CA 92173-1345 · (619) 662-4100
Phone(619) 662-4100
Sole ProprietorNo
Enumeration DateMarch 24, 2017
Last NPPES UpdateAugust 11, 20202 updates tracked since enumeration
NPPES CertifiedAugust 11, 2020
✔ NPI 1790216422 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CA · 169577
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
4050 BEYER BLVD, San Ysidro, CA 92173
Open in Google Maps ↗

Secondary Practice Location 1

Location 113001 E 17th PlAurora, CO 80045-2570 · Phone (720) 777-6738

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Elissa Kim Sullivan Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Elissa Sullivan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Centro De Salud De La Comunidad De San Ysidro Inc
Same address
Federally Qualified Health Center (FQHC)
4050 BEYER BLVD
San Ysidro, CA 92173
  • Reassigned Medicare billing, California enrollment
  • 577 clinicians in this Medicare group
NPI 1558852947 (619) 662-4100

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92173 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
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$108.42 typical visit price
range $20.62 – $151.42
Typical copayment $27.10 (range $5.15 – $37.85)
Most-billed visit code 99214
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 8

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

DR. PATRICIA A GOMEZ-NARANJO MD
Psychiatry & Neurology (Child & Adolescent Psychiatry)
4050 BEYER BLVD
SAN YSIDRO, CA 92173
San Diego County (619) 662-4100
DR. REGINA MARIE JAVIER GARCIA DMD
Dentist
4050 BEYER BLVD
SAN DIEGO, CA 92173
San Diego County (619) 662-4100
MS. KELLEY ALEXIS BUTLER MD, MPH
Family Medicine
4050 BEYER BLVD
SAN YSIDRO, CA 92173
San Diego County (619) 662-4100
CHANMEE PRAISE SEO MD
Family Medicine
4050 BEYER BLVD
SAN YSIDRO, CA 92173
San Diego County (619) 662-4100
DR. JONATHAN DANIEL MILLS DDS
Dentist (Pediatric Dentistry)
4050 BEYER BLVD
SAN YSIDRO, CA 92173
San Diego County (619) 662-4100
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO INC
Clinic/Center (Federally Qualified Health Center (FQHC))
4050 BEYER BLVD
SAN YSIDRO, CA 92173
San Diego County (619) 662-4100
ANDRES ALONSO GOMEZ GARZA MD
Pediatrics
4050 BEYER BLVD
SAN YSIDRO, CA 92173
San Diego County (619) 662-4100
DIANA LUC
Dentist (Pediatric Dentistry)
4050 BEYER BLVD
SAN DIEGO, CA 92173
San Diego County (619) 662-4100

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 Elissa Sullivan's NPI number?

The NPI number for Elissa Sullivan is 1790216422. It was assigned to this individual provider in the NPPES registry on March 24, 2017.

Where is Elissa Sullivan located?

Elissa Sullivan practices at 4050 Beyer Blvd, San Ysidro, CA 92173. The listed phone number is (619) 662-4100.

What is Elissa Sullivan's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Elissa Sullivan enrolled in Medicare?

Yes. Elissa Sullivan is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Elissa Sullivan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Elissa Sullivan reassigns Medicare benefits to Centro De Salud De La Comunidad De San Ysidro Inc (San Ysidro, 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 Elissa 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 Elissa Sullivan was last updated on August 11, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.