Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mary-Marie Austin Sullivan, MD

Individual provider Family Medicine Physician · NPI 1770872319

Mary-Marie Austin Sullivan, MD is a Family Practice in Provo, Utah. Graduated from University of Utah School of Medicine in 2011, 15 years ago. Practices with Ihc Health Services Inc, a 3,947-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Utah.

Years since qualifying
15
Trained at
University of Utah School of Medicine
Licensed in
UT
In the registry since
2011
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1134 N 500 W Ste 102
Provo, UT 84604-5569
Phone: (801) 341-5200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 8380179-1205 (UT)

Record details

NPI number1770872319
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 5, 2011
Last updated in NPPESSeptember 14, 2021
Certification dateSeptember 14, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolUNIVERSITY OF UTAH SCHOOL OF MEDICINE
Graduated 2011 (15 years in practice)
Group practice Ihc Health Services Inc — 3947 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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