NPIMap

Individual provider Active NPI

Susan Malton Okkerse, CRNA

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1033394283
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
31372 Issued in NC
Practice address
8800 North Tryon Street
Charlotte, NC 28262-3300
Phone
(704) 863-5665
Fax
(704) 863-5848
NPI assigned
Jan 7, 2008
Last updated
May 22, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 31372 NC Primary

Addresses

Primary practice location

8800 North Tryon Street
Charlotte, NC 28262-3300

Mailing address

PO Box 560727
Anesthesia Department
Charlotte, NC 28256-0727
Phone (704) 863-5665

Other identifiers 4

IdentifierTypeStateIssuer
NAN540MedicaidSC
182152OtherNCRN LICENSE
31372OtherAANA LICENSE
8051739MedicaidNC

Other names 1

  • Susan Elizabeth Malton Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
31372NCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center - University Nurse Anesthetist, Certified Registered Past Accepting new patients
Mooresville Hospital Management Associates LLC Past Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Past Accepting new patients
The Presbyterian Hospital Nurse Anesthetist, Certified Registered Past Accepting new patients
Mooresville Hospital Management Associates, LLC Nurse Anesthetist, Certified Registered Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1033394283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 560727",
            "address_2": "ANESTHESIA DEPARTMENT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282560727",
            "telephone_number": "704-863-5665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8800 NORTH TRYON STREET",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282623300",
            "telephone_number": "704-863-5665",
            "fax_number": "704-863-5848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKKERSE",
        "first_name": "SUSAN",
        "middle_name": "MALTON",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-07",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "31372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NAN540",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "182152",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AANA LICENSE",
            "identifier": "31372",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8051739",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "MALTON",
            "middle_name": "ELIZABETH",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; 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.