Irawan Susanto, MD

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

License

C50280 Issued in CA

Practice address

1223 16TH St
Suite 3400
Santa Monica, CA 90404-1217

Phone

(310) 449-0939

Fax

(424) 259-7790

NPI assigned

Jul 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

87.51 of 100Reported as group

Quality

79.37

Promoting interoperability

100

Improvement activities

40

Cost

73.65

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: isusanto48396@direct.uclahealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• UCLA Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1043427248
  NPD (past)
• Delphi OB-GYN Group of Montgomery County LLC

  • Obstetrics & Gynecology Physician
  • Olney, MD
  • NPI 1780881615
  NPD (past)

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391644800000",
    "number": "1003836610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD",
            "address_2": "SUITE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455632",
            "telephone_number": "310-301-8708",
            "fax_number": "310-301-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 16TH ST",
            "address_2": "SUITE 3400",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041217",
            "telephone_number": "310-449-0939",
            "fax_number": "424-259-7790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSANTO",
        "first_name": "IRAWAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2014-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "C50280",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CA",
            "license": "C50280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C502800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Denise K Sur
• Ashley Suraweera, MD
• Surgical Associates of Santa Monica a Medical Group
• Surgiluxe Inc
• Susan T Henderson
• Thomas Michael Susko, M.D.
• Valerie Goldfine Susman
• Rachel Rose Mercado Suson, PT, DPT
• Shereen Sutphen
• Maya Sutta-Gomez

• Critical Care Medicine (Internal Medicine) Physician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Critical Care Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.