Kirk L Susott, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

4301039087 Issued in MI

Practice address

325 E H St
Oscar G. Johnson VA Medical Center
Iron Mountain, MI 49801-4760

Phone

(906) 774-3300

Fax

(906) 779-3124

NPI assigned

Aug 12, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386028800000",
    "number": "1003818683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 E H ST",
            "address_2": "OSCAR G. JOHNSON VA MEDICAL CENTER",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498014760",
            "telephone_number": "906-774-3300",
            "fax_number": "906-779-3124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 E H ST",
            "address_2": "OSCAR G. JOHNSON VA MEDICAL CENTER",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498014760",
            "telephone_number": "906-774-3300",
            "fax_number": "906-779-3124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSOTT",
        "first_name": "KIRK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2013-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MI",
            "license": "4301039087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4758301",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4777174",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald Stickel, CO
• Thad Q Strom, PH.D.
• Superior Pharmacy Services Inc
• Susan E. Arcaro
• Chad Bricker Susott, D.D.S
• Heather Ann Sweig
• Patrycja Swiercz
• Karen Hazel Swiss
• Robert Tacia, DO
• Christine Talerico

• Urology Physician in Iron Mountain, MI
• Providers in Iron Mountain, MI by specialty
• Urology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.