NPIMap

Individual provider Active NPI

Susan T Federoff, MD

  • Family Medicine Physician
  • Wexford, PA
National Provider Identifier
1083683213
Registry record updated Jul 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD045519E Issued in PA
Practice address
1500 Village Run Rd
Suite 308
Wexford, PA 15090-6316
Phone
(724) 934-1900
Fax
(724) 934-3388
NPI assigned
Mar 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD045519E PA Primary

Addresses

Primary practice location

1500 Village Run Rd
Suite 308
Wexford, PA 15090-6316

Mailing address

1500 Village Run Road
Suite 308
Wexford, PA 15090
Phone (724) 934-1900

Other identifiers 1

IdentifierTypeStateIssuer
001746773MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20240119003007 MD Practitioner - Family Practice 9739194333 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

311 N 4TH St
Oakland, MD 21550-1371
Phone (301) 334-8171

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD045519EPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Specialty Physicians of Garrett County, LLC CurrentSince Dec 11, 2023 Accepting new patients
Specialty Physicians of Garrett County, LLC Current Accepting new patients
Specialty Physicians of Garrett County, LLC CurrentSince Dec 11, 2023 Accepting new patients

Locations

311 N 4th St
Oakland, MD 21550
Phone (301) 334-7420

880 Memorial Dr
Lowr Level
Oakland, MD 21550
Phone (301) 334-1177

Organizations & group practices 3

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 10

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": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343174400000",
    "number": "1083683213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 VILLAGE RUN ROAD",
            "address_2": "SUITE 308",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "15090",
            "telephone_number": "724-934-1900",
            "fax_number": "724-934-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 VILLAGE RUN RD",
            "address_2": "SUITE 308",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150906316",
            "telephone_number": "724-934-1900",
            "fax_number": "724-934-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDEROFF",
        "first_name": "SUSAN",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2012-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD045519E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001746773",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wexford, PA

Sources for this page

Verify at the official NPI Registry.