Susan Theresa Iannaccone, MD
Individual provider Active NPI Neurology Physician · Dallas, TX
NPI 1023078607 · NPPES record last updated Apr 26, 2024
Key facts
- NPI
- 1023078607
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neurology Physician 2084N0400X
- License
- H8691 (TX)
- Practice address
- 5323 Harry Hines Boulevard
Dallas, TX 75390-7208 - Phone
- (214) 456-2768
- Fax
- (214) 456-6898
- NPI assigned
- Mar 27, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- State University of Ny Upstate Medical University, 1969
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- University of Texas Southwestern Medical Center at Dallas
Practice addresses (Care Compare)
2222 Welborn St
Dallas, TX 75219-3924
Phone (214) 559-5000
2350 N Stemmons Frwy
Dallas, TX 75207-2700
Phone (844) 424-4537
2350 N Stemmons Fwy
Dallas, TX 75207-2700
2350N Stemmons Fwy 4300
Dallas, TX 75207-2700
Phone (214) 645-0624
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: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041123001280 | TX | Practitioner - Pediatric Medicine |
2264497767 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H8691 | TX | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The University of Texas Southwestern Medical Center at Dallas | Current |
Accepting new patients | |
| University of Texas Southwestern Medical Center at Dallas | Current | Accepting new patients | |
| University of Texas Southwestern Medical Center at Dallas | Neurology | Current |
Accepting new patients |
Locations
2222 Welborn St
Dallas, TX 75219
Phone (214) 559-5000
420 E 6th St
Ste 202
Odessa, TX 79761
Phone (214) 648-9618
5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390
5303 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390
Phone (214) 645-2300
Interoperability endpoints
- susan.iannaccone@direct.swmed.us
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | H8691 | TX | Yes |
| Neurology with Special Qualifications in Child Neurology Physician | 2084N0402X | H8691 | TX |
Addresses
Primary practice location
5323 Harry Hines Boulevard
Dallas, TX 75390-7208
Mailing address
P.O. Box 845347
Dallas, TX 75284-5347
Phone (214) 456-2768
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105947903 | Medicaid | TX |
Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2024. 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.