DR. LISA C. SULLIVAN (NPI# 1841380375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841380375 |
| Entity Type | Individual |
| Full Name | DR. LISA C. SULLIVAN |
| Credential | M.D. |
| Practice Address |
4950 Se Roethe Rd Milwaukie OR 97267-5746 |
| Mailing Address |
421 Sw Oak St Ste 210 Portland OR 97204-1817 |
| Practice Telephone | 5037226858 |
| Practice Fax Number | 5037226826 |
| Mailing Telephone | 5039887468 |
| Mailing Fax Number | 5039887468 |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2019-06-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | MD24619 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 096511 | 05 | |
| OR | 22959 | 05 | |
| OR | 240558 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285282459 | Lisa Sullivan | Behavior Technician | 719 N Hillview Dr, Boise, ID 83712-8122 | 2019-08-29 |
| 1184183550 | Lisa Sullivan | Contractor | 113 Constitution Ct Apt A, Albany, GA 31721-2150 | 2019-03-15 |
| 1366875197 | Lisa Sullivan | Counselor | 3740 Colony Dr Ste 260, San Antonio, TX 78230-2233 | 2013-08-15 |
| 1336486414 | Lisa Marie Sullivan | Social Worker | 18 Rose Pl, Selden, NY 11784-3122 | 2013-01-10 |
| 1144579418 | Lisa Sullivan | Specialist | 252 California Ct, Mission Viejo, CA 92692-4098 | 2012-09-02 |
| 1811205750 | Lisa Renee Sullivan | Physician Assistant | 44305 Harmony Ln, Belleville, MI 48111-2449 | 2010-09-14 |
| 1700014065 | Lisa Hadeler Sullivan | Physical Therapist | 1420 Hwy 36, Hazlet, NJ 07730-1736 | 2009-06-25 |
| 1083874127 | Lisa Meghan Sullivan | Massage Therapist | 1640 Selby Ave Apt 6, Saint Paul, MN 55104-7379 | 2008-06-12 |
| 1386650273 | Lisa Marie Sullivan | Allergy & Immunology | 737 Saint Johns Ave, Highland Park, IL 60035-4650 | 2006-07-31 |
| 1023059813 | Lisa Hope Sullivan | Physical Therapist | 15 Neil Ct, Inside Jcc, Oceanside, NY 11572-5815 | 2006-06-10 |
| Street Address |
4950 SE ROETHE RD |
| City | MILWAUKIE |
| State | OR |
| Zip Code | 97267-5746 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831697259 | Outside In | Clinic/Center | 4950 Se Roethe Rd, Milwaukie, OR 97267-5746 | 2018-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851911036 | Michelle Renee Gilham | Massage Therapist | 16560 S.e. 80th Ave, Portland Or 97267, 19650 Se 80th Ave, Portland, OR 97267 | 2020-04-17 |
| 1629557442 | Benchmark Physical Therapy of Or, LLC | Occupational Therapist | 14874 Se Webster Rd, Milwaukie, OR 97267 | 2018-08-13 |
| 1326541764 | Theresa Elaine Day | Massage Therapist | 2080 Se Oak Grove Blvd Ste 16, Portland, OR 97267 | 2018-03-12 |
| 1881015378 | Kathryn Louise Engstrom | Registered Nurse | 6901 Se Lake Road, Portland, OR 97267 | 2013-12-30 |
| 1285951293 | Eliza Ann Rowley | Acupuncturist | 2080 Se Oak Grove Blvd #9, Milwaukie, OR 97267 | 2010-04-29 |
| 1346438124 | Rx Direct Inc | Pharmacy | 16246 Se Mcloughlin, Milwaukie, OR 97267 | 2007-10-05 |
| 1477740827 | Olson Drug, Inc | Durable Medical Equipment & Medical Supplies | 16244 Se Mcloughlin Blvd, Milwaukie, OR 97267 | 2007-10-01 |
| 1831308451 | Jeannie Marie Baer | Massage Therapist | 16705 Se Mcloughlin, Milwaukie, OR 97267 | 2007-05-21 |
| 1902923667 | Matthew William Krueger | Specialist/Technologist | 4950 Se Roethe Rd., Milwaukie, OR 97267 | 2007-03-26 |
| 1316084049 | Renee' Lorena Raschke | Counselor | 17070se Mcloughlin Blvd., Milwaukie, OR 97267 | 2007-01-31 |
| Find all providers in zip 97267 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659369304 | Donald W. Fortlage | Pediatrics | 10202 Se 32nd Ave, Suite 201, Milwaukie, OR 97222-3610 | 2005-10-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114558368 | Oregon Pediatrics-oregon City, PC | Pediatrics | 1510 Division St Ste 80, Oregon City, OR 97045-1572 | 2020-01-27 |
| 1962911347 | Bend Kids Pediatrics, LLC | Pediatrics | 2748 Nw Crossing Dr Ste 140, Bend, OR 97703-7179 | 2017-09-28 |
| 1730606716 | Meghan Louise Lacy | Pediatrics | 11790 Sw Barnes Rd, Blg. A, Suite 140, Portland, OR 97225 | 2017-08-29 |
| 1235660176 | Erik Grimm | Pediatrics | 16463 Boones Ferry Rd Ste 400, Lake Oswego, OR 97035-4377 | 2017-03-22 |
| 1891178885 | Snake River Pediatrics | Pediatrics | 1050 Sw 3rd Ave Ste 3200, Ontario, OR 97914-4560 | 2015-07-08 |
| 1447663810 | Anh Linh Hoang | Pediatrics | 9243 Ne Glisan St, Portland, OR 97220-4533 | 2014-06-03 |
| 1891126538 | Sydmarie Bisenius | Pediatrics | 24850 Se Stark St Ste 150, Gresham, OR 97030-8318 | 2013-12-05 |
| 1427499367 | Elizabeth Bish Young | Pediatrics | 901 Bellwood Ln, Roseburg, OR 97471-9299 | 2013-07-08 |
| 1255771671 | Steven Donald Mcgaughey | Pediatrics | Ohsu Doernbecher, 3181 Sw Sam Jackson Park Road, Portland, OR 97239-1002 | 2013-06-29 |
| 1508109539 | Ramya Mishra Jariwala | Pediatrics | 9155 Sw Barnes Rd Ste 840, Portland, OR 97225 | 2013-03-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.