Michael Vittorio Susano, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

025874 Issued in LA

Practice address

1310 N Hearne Ave
Shreveport, LA 71107-6516

Phone

(318) 676-5111

NPI assigned

Jun 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Louisiana State University School of Medicine in Shreveport, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Lousiana Human Services DistrictGroup PAC ID 1456580398, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michealsusanomd@nlhsd.direct.kno2fy.com

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.

• Northwest Lousiana Human Services District

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Shreveport, LA
  • NPI 1821421686
  Medicare reassignment Care Compare group NPD
• Northwest Lousiana Human Services District

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Natchitoches, LA
  • NPI 1366875874
  NPD
• Northwest Lousiana Human Services District

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minden, LA
  • NPI 1144653817
  NPD (past)

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463616000000",
    "number": "1063440105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 MEDICAL CIR",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754822138",
            "telephone_number": "318-869-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 N HEARNE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711076516",
            "telephone_number": "318-676-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSANO",
        "first_name": "MICHAEL",
        "middle_name": "VITTORIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2016-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "025874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1041840",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Psychiatry Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.