Susie Kim Ahn, FNP
Individual provider Active NPI Family Nurse Practitioner · Allen, TX
NPI 1003816232 · NPPES record last updated Oct 19, 2023
Key facts
- NPI
- 1003816232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 712630 (TX)
- Practice address
- 1105 Central Expy N Ste 2240
Allen, TX 75013-6114 - Phone
- (866) 607-2308
- NPI assigned
- Jul 29, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- University of California, Geffen School of Medicine, 2002
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Legacy Heart Care of Fort Worth, LLC
Legacy Heartcare of Dallas, LLC
Legacy Heart Care of Grand Prairie, LLC
Legacy Heart Care of North Dallas LLC
Practice addresses (Care Compare)
2500 W Fwy
Suite 200
Fort Worth, TX 76102-5851
Phone (817) 753-8973
4716 Dexter Dr
Suite 200
Plano, TX 75093-5562
Phone (972) 490-9500
4927 Lake Ridge Pkwy
Suite 145
Grand Prairie, TX 75052-3087
Phone (817) 423-4400
7515 Greenville Ave
Suite 1010
Dallas, TX 75231-3858
Phone (972) 838-7255
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050629000126 | TX | Practitioner - Nurse Practitioner | 0840187704 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 712630 | TX | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Heart Care of North Dallas, LLC | Current |
Accepting new patients | |
| Legacy Heartcare of Dallas, LLC | Current |
Accepting new patients | |
| Legacy Heart Care of Grand Prairie, LLC | Current |
Accepting new patients | |
| Legacy Heartcare of Dallas, LLC | Current |
Accepting new patients | |
| Legacy Heart Care of South Austin, LLC | Current |
Accepting new patients | |
| Legacy Heart Care of San Antonio | Current |
Accepting new patients | |
| Legacy Heart Care of San Antonio | Current |
Accepting new patients | |
| Legacy Heart Care of Fort Worth, LLC | Current |
Accepting new patients | |
| Legacy Heart Care of Midtown Austin, LLC | Current |
Accepting new patients |
Locations
7515 Greenville Ave
Ste 1010
Dallas, TX 75231
Phone (972) 838-7255
2500 West Fwy
Ste 200
Ft Worth, TX 76102
Phone (817) 423-4400
4927 Lake Ridge Pkwy
Ste 145
Grand Prairie, TX 75052
Phone (817) 423-4400
1180 Seton Pkwy
Ste 280
Kyle, TX 78640
Phone (817) 710-7644
12702 Toepperwein Rd
Ste 123
Live Oak, TX 78233
Phone (210) 934-4100
7300 Eldorado Pkwy
Ste 105
McKinney, TX 75070
Phone (945) 200-6880
4716 Dexter Dr
Ste 200
Plano, TX 75093
Phone (817) 502-7027
7200 Wyoming Springs Dr
Ste 300
Round Rock, TX 78681
Phone (512) 419-1100
3903 Wiseman Blvd
Ste 114
San Antonio, TX 78251
Phone (210) 256-9467
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 712630 | TX | Yes |
Addresses
Primary practice location
1105 Central Expy N Ste 2240
Allen, TX 75013-6114
Mailing address
PO Box 570492
Dallas, TX 75357-0492
Phone (562) 714-8609
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 173668801 | Medicaid | TX |
Other providers in Allen, TX
- Sulman Ahmed
- Tanveer Ahmed
- Tayyaba S Ahmed
- Zainab Ahmed I
- Hyeri Hailey Ahn
- Sharanya Ajaykumar
- Juliana Akabua
- Venkataramasireesha Akaveeti
- Saleem Akbar
- Asma Akhtar
All providers in Allen, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.