NPIMap

Individual provider Active NPI

Susan Syty, PA-C

  • Physician Assistant
  • Harwich Port, MA
National Provider Identifier
1053631523
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA8941 Issued in MA
Practice address
710 Route 28
Harwich Port, MA 02646-1931
Phone
(508) 432-1400
NPI assigned
Jun 8, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA054377 PA
Physician Assistant 363A00000X PA8941 MA Primary

Addresses

Primary practice location

710 Route 28
Harwich Port, MA 02646-1931

Mailing address

PO Box 598
Harwich Port, MA 02646-0598
Phone (508) 432-1400

Other names 1

  • Susan Shadle Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20231204002700 MA Practitioner - Physician Assistant 5991829459 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Outer Cape Health Services IncGroup PAC ID 4385554971, 51 clinicians

Practice addresses (Care Compare)

49 Harry Kemp Way
Provincetown, MA 02657-1618
Phone (508) 487-9395

710 Route 28
Harwich Port, MA 02646-1931
Phone (508) 432-1400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Outer Cape Health Services, Inc. CurrentSince Dec 18, 2023 Accepting new patients
Tri-County Emergency Physicians, Inc Past Accepting new patients
Tri-County Emergency Physicians Inc Past Accepting new patients
Einstein Practice Plan Inc Past Accepting new patients

Locations

49 Harry Kemp Way
Provincetown, MA 02657
Phone (508) 487-9395

3130 State Hwy Rte 6
Wellfleet, MA 02667
Phone (508) 349-3131

Organizations & group practices 4

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

Hospital & facility affiliations 7

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": "1275955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1053631523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 598",
            "city": "HARWICH PORT",
            "state": "MA",
            "postal_code": "026460598",
            "telephone_number": "508-432-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 ROUTE 28",
            "city": "HARWICH PORT",
            "state": "MA",
            "postal_code": "026461931",
            "telephone_number": "508-432-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYTY",
        "first_name": "SUSAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-08",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA054377",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA8941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "SHADLE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Harwich Port, MA

Sources for this page

Verify at the official NPI Registry.