Dr Sullivan Clyde Hanback, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Houston, Texas. He went to University Of Alabama School Of Medicine and graduated in 2021 and has 4 years of diverse experience with area of expertise as Emergency Medicine. He is a member of the group practice Temple Faculty Practice Plan Inc and his current practice location is
6431 Fannin Street, Suite Jjl 270-6, Houston, Texas. You can reach out to his office (for appointments etc.) via phone at
(713) 500-7878.
Dr Sullivan Clyde Hanback is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1417538141.
Physician's Profile
| Full Name | Dr Sullivan Clyde Hanback |
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| Gender | Male |
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| Speciality | Emergency Medicine |
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| Experience | 4 Years |
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| Location | 6431 Fannin Street, Houston, Texas |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Sullivan Clyde Hanback attended and graduated from University Of Alabama School Of Medicine in 2021
NPI Data:
- NPI Number: 1417538141
- Provider Enumeration Date: 04/15/2021
- Last Update Date: 06/30/2023
Medicare PECOS Information:
- PECOS PAC ID: 0941647259
- Enrollment ID: I20240322000301
Medical Identifiers
Medical identifiers for Dr Sullivan Clyde Hanback such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1417538141 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207P00000X | Emergency Medicine | U4523 (Texas) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Temple Faculty Practice Plan Inc | 0345588711 | 1191 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Sullivan Clyde Hanback allows following entities to bill medicare on his behalf.
| Entity Name | Temple Faculty Practice Plan Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1881176949
PECOS PAC ID: 0345588711
Enrollment ID: O20190208002623 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Sullivan Clyde Hanback is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Sullivan Clyde Hanback, MD
6431 Fannin Street, Suite Jjl 270-6,
Houston, TX 77030
Ph: (713) 500-7878 | Dr Sullivan Clyde Hanback, MD
6431 Fannin Street, Suite Jjl 270-6,
Houston, TX 77030
Ph: (713) 500-7878 |
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