Individual provider Active NPI

Susan N Thompson, M.D.

  • Family Medicine Physician
  • Great Barrington, MA
National Provider Identifier
1104824804
Registry record updated Nov 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
54979 Issued in MA
Practice address
63 State Rd
Great Barrington, MA 01230-1223
Phone
(413) 644-9933
Fax
(413) 644-9433
NPI assigned
Jul 7, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 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 54979 MA Primary

Addresses

Primary practice location

63 State Rd
Great Barrington, MA 01230-1223

Mailing address

63 State Rd
Great Barrington, MA 01230-1223
Phone (413) 644-9933

Other identifiers 13

IdentifierTypeStateIssuer
1104824804OtherHEALTH NEW ENGLAND
1104824804OtherCIGNA
1104824804OtherTUFTS
1104824804OtherUNITED HEALTH CARE PLAN SPECIFIC
1104824804OtherAETNA
1104824804OtherMABOSTON MEDICAL HEALTH PLAN
1104824804OtherCDPHP
1104824804OtherFALLON
1104824804OtherMVP
1104824804OtherRAILROAD MEDICARE
1104824804OtherMABC/BS MA - BLUE CARD PPO
11004271AMedicaidMA
1104824804OtherHARVARD PILGRM HEALTH CARE

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

Interoperability endpoints

  • Direct secure messaging: susan.thompson.1@13063.direct.athenahealth.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353888000000",
    "number": "1104824804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 STATE RD",
            "city": "GREAT BARRINGTON",
            "state": "MA",
            "postal_code": "012301223",
            "telephone_number": "413-644-9933",
            "fax_number": "413-644-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 STATE RD",
            "city": "GREAT BARRINGTON",
            "state": "MA",
            "postal_code": "012301223",
            "telephone_number": "413-644-9933",
            "fax_number": "413-644-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "SUSAN",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2012-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "54979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NEW ENGLAND",
            "identifier": "1104824804",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1104824804",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "1104824804",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE PLAN SPECIFIC",
            "identifier": "1104824804",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1104824804",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOSTON MEDICAL HEALTH PLAN",
            "identifier": "1104824804",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "1104824804",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON",
            "identifier": "1104824804",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "1104824804",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "1104824804",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS MA - BLUE CARD PPO",
            "identifier": "1104824804",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11004271A",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRM HEALTH CARE",
            "identifier": "1104824804",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Barrington, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 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.

Verify at the official NPI Registry.