NPIMap

Individual provider Active NPI

Susan M Klotz, FNP-C

  • Family Nurse Practitioner
  • Ash Grove, MO
National Provider Identifier
1033555933
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2013012284 Issued in MO
Practice address
609 E Wells St Ste B
Ash Grove, MO 65604-9087
Phone
(417) 234-3621
Fax
(949) 655-7855
NPI assigned
May 17, 2013
Last updated
Jul 29, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2013012284 MO Primary

Addresses

Primary practice location

609 E Wells St Ste B
Ash Grove, MO 65604-9087

Mailing address

12374 W Farm Road 60
Ash Grove, MO 65604-8766
Phone (417) 234-3621

Other practice location 1

1235 E Cherokee St
Floor 2D
Springfield, MO 65804-2203
Phone (417) 820-2364

Other practice location 2

12374 W Farm Road 60
Ash Grove, MO 65604-8766
Phone (141) 723-4362

Other identifiers 1

IdentifierTypeStateIssuer
1033555933MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130827000369 MO Practitioner - Nurse Practitioner 9830332659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

609 E Wells St
Suite B
Ash Grove, MO 65604-9098
Phone (417) 363-7002

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2013012284MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Your Health Consultant Family CurrentSince Jul 16, 2020 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: sklotz678119@directb.mercy.net

Organizations & group practices 2

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1368748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1033555933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12374 W FARM ROAD 60",
            "city": "ASH GROVE",
            "state": "MO",
            "postal_code": "656048766",
            "telephone_number": "417-234-3621",
            "fax_number": "949-655-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 E WELLS ST STE B",
            "city": "ASH GROVE",
            "state": "MO",
            "postal_code": "656049087",
            "telephone_number": "417-234-3621",
            "fax_number": "949-655-7855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1235 E Cherokee St",
            "address_2": "Floor 2D",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658042203",
            "country_code": "US",
            "telephone_number": "417-820-2364",
            "fax_number": "417-820-7136",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12374 W Farm Road 60",
            "address_purpose": "LOCATION",
            "city": "Ash Grove",
            "state": "MO",
            "postal_code": "656048766",
            "country_code": "US",
            "telephone_number": "141-723-4362",
            "fax_number": "949-655-7855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLOTZ",
        "first_name": "SUSAN",
        "middle_name": "M",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-17",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2013012284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033555933",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ash Grove, MO

Sources for this page

Verify at the official NPI Registry.