Susan Kay Boland, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2122-23 Issued in WI

Practice address

300 North Washington Street
Darien Medical Clinic
Darien, WI 53114-1534

Phone

(262) 882-1151

Fax

(262) 296-1195

NPI assigned

Mar 26, 2007

Last updated

Mar 8, 2011By the provider in NPPES

Sex

Female

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

Other names 1

• Susan Kay Pendell-Rogers Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Beloit Health System, Inc

  dba Hendricks Family Heart Hospital

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Beloit, WI
  • NPI 1568677417
  NPD (past)

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299542400000",
    "number": "1023136512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 E. HUEBBE PARKWAY",
            "address_2": "BELOIT HEALTH SYSTEM INC",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111842",
            "telephone_number": "608-364-2200",
            "fax_number": "608-363-7395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 NORTH WASHINGTON STREET",
            "address_2": "DARIEN MEDICAL CLINIC",
            "city": "DARIEN",
            "state": "WI",
            "postal_code": "531141534",
            "telephone_number": "262-882-1151",
            "fax_number": "262-296-1195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAND",
        "first_name": "SUSAN",
        "middle_name": "KAY",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2011-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085001543",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2122-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023136512",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "PENDELL-ROGERS",
            "middle_name": "KAY",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ulma Anclam, PTA
• Beloit Health System, Inc (darien medical center)
• Lynn Marie Dutton, RN
• Angela A Fox, LPN
• Hillary L Kreager, PA
• Traci J Lebow, RN
• Margaret Grace McGraw, PA-C

• Physician Assistant in Darien, WI
• Providers in Darien, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.