Individual provider Active NPI

Susan Marie Perez, NP

  • Pediatric Nurse Practitioner
  • Kalamazoo, MI
National Provider Identifier
1013163047
Registry record updated Dec 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
4704150329 Issued in MI
Practice address
117 W Paterson St
Kalamazoo, MI 49007-2557
Phone
(269) 349-2641
NPI assigned
Aug 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 4704150329 MI Primary

Addresses

Primary practice location

117 W Paterson St
Kalamazoo, MI 49007-2557

Mailing address

117 W Paterson St
Kalamazoo, MI 49007-2557
Phone (269) 349-2641

Other practice location 1

505 E Alcott St
Kalamazoo, MI 49001-6144
Phone (269) 349-2641

Medicare participation

Medicare enrollment files
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704150329MIMDPediatric Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1218412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672099200000",
    "number": "1013163047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 W PATERSON ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490072557",
            "telephone_number": "269-349-2641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 W PATERSON ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490072557",
            "telephone_number": "269-349-2641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 E Alcott St",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490016144",
            "country_code": "US",
            "telephone_number": "269-349-2641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-11",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704150329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.