Susan Lee Ivey, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

C43335 Issued in CA

Practice address

2140 Shattuck Ave
10TH Floor, Health Research for Action, UC-Berkeley SPH
Berkeley, CA 94704-1210

Phone

(510) 643-1883

Fax

(510) 643-7976

NPI assigned

Oct 12, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192147200000",
    "number": "1003004169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 EMERALD DR",
            "city": "DANVILLE",
            "state": "CA",
            "postal_code": "945262426",
            "telephone_number": "925-362-8227",
            "fax_number": "925-362-8228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 SHATTUCK AVE",
            "address_2": "10TH FLOOR, HEALTH RESEARCH FOR ACTION, UC-BERKELEY SPH",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947041210",
            "telephone_number": "510-643-1883",
            "fax_number": "510-643-7976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVEY",
        "first_name": "SUSAN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-12",
        "last_updated": "2007-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C43335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.