Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Ronin Anthony Sullivan

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1104408285

Mr. Ronin Anthony Sullivan is a Physician Assistant in Denver, Colorado. Qualified in 2022, 4 years ago. Practices with Southeast Alaska Regional Health Consortium, a 368-clinician group and accepts Medicare assignment.

Years since qualifying
4
In the registry since
2021
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Practice location Address checks out

17858 E 54th Ave
Denver, CO 80249-8819
Phone: (850) 543-7434
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1104408285
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedApril 27, 2021
Last updated in NPPESApril 27, 2021
Certification dateApril 27, 2021
Mailing address17858 E 54th Ave, Denver, CO 80249-8819

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Southeast Alaska Regional Health Consortium — 368 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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