Active NPI
Susan R. Middleton, M.D.
- Psychiatry Physician
- Pueblo, CO
National Provider Identifier
1093743247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 28461
- Practice address
- 56 Club Manor Dr
Pueblo, CO 81008-1679 - Phone
- (719) 584-4767
- Fax
- (719) 595-7906
- NPI assigned
- Jun 28, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 28461 | CO | Primary |
Addresses
Primary practice location
56 Club Manor Dr
Pueblo, CO 81008-1679
Mailing address
400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4767
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 |
|---|---|---|---|
| 28461 | CO | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344470400000",
"number": "1093743247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 W 16TH ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810032745",
"telephone_number": "719-584-4767",
"fax_number": "719-595-7906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "56 CLUB MANOR DR",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081679",
"telephone_number": "719-584-4767",
"fax_number": "719-595-7906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIDDLETON",
"first_name": "SUSAN",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-28",
"last_updated": "2012-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CO",
"license": "28461",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.