Susan D Peck, RN, PHD, GNP-BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

325-033 Issued in WI

Practice address

2130 Brackett Ave Ste B
Eau Claire, WI 54701-4928

Phone

(715) 895-8571

Fax

(715) 895-8573

NPI assigned

Oct 4, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy, Registered Nurse

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18208/brand/1/csg/1/fhir/r4

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.

• Elite Therapy Institute LLC

  • Physical Therapy Clinic/Center
  • Rice Lake, WI
  • NPI 1760576789
  NPD (past)

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552262400000",
    "number": "1104813179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 WILSON ST",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547014808",
            "telephone_number": "715-829-7325",
            "fax_number": "715-895-8573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 BRACKETT AVE STE B",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547014928",
            "telephone_number": "715-895-8571",
            "fax_number": "715-895-8573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "SUSAN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "RN, PHD, GNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-04",
        "last_updated": "2019-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WI",
            "license": "325-033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Peak, SAC-IT
• Pearle Vision Inc
• Cameron Fredrick Pearson, DPT
• Madilyn Pearson, M.A. CCC SLP
• Robert Curtis Peck, MD
• Sarah J. Pedersen, RDH, CDHC
• Lori Pederson
• Miranda S Pederson, CSAC
• Thomas Edward Pederson, MD
• Johann M Peikert, MD

• Gerontology Nurse Practitioner in Eau Claire, WI
• Providers in Eau Claire, WI by specialty
• Gerontology Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.