Active NPI
Susan L Church, MD
- Pediatrics Physician
- Rocky Mount, NC
National Provider Identifier
1093709701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 28956
- Practice address
- 100 Nash Medical Arts Mall
Rocky Mount, NC 27804-1400 - Phone
- (252) 451-3100
- Fax
- (252) 451-3141
- NPI assigned
- Sep 8, 2005
- Last updated
- Aug 22, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 28956 | NC | Primary |
| Neonatal-Perinatal Medicine Physician | 2080N0001X | 28956 | NC |
Addresses
Primary practice location
100 Nash Medical Arts Mall
Rocky Mount, NC 27804-1400
Mailing address
100 Nash Medical Arts Mall
Rocky Mount, NC 27804-1400
Phone (252) 451-3100
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22480 | Other | NC | BCBSNC |
| 7922480 | Medicaid | NC | |
| 1521919 | Other | NC | CIGNA HEALTHCARE |
| 69963 | Other | NC | MEDCOST |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28956 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187740800000",
"number": "1093709701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 NASH MEDICAL ARTS MALL",
"city": "ROCKY MOUNT",
"state": "NC",
"postal_code": "278041400",
"telephone_number": "252-451-3100",
"fax_number": "252-451-3141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 NASH MEDICAL ARTS MALL",
"city": "ROCKY MOUNT",
"state": "NC",
"postal_code": "278041400",
"telephone_number": "252-451-3100",
"fax_number": "252-451-3141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHURCH",
"first_name": "SUSAN",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-08",
"last_updated": "2007-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "28956",
"primary": true
},
{
"code": "2080N0001X",
"taxonomy_group": "",
"desc": "Pediatrics, Neonatal-Perinatal Medicine",
"state": "NC",
"license": "28956",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSNC",
"identifier": "22480",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7922480",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTHCARE",
"identifier": "1521919",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "69963",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rocky Mount, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.