Individual provider Active NPI

Susan St.Clair Roper, M.D.

  • Dermatology Physician
  • Clearwater, FL
National Provider Identifier
1114039732
Registry record updated Jan 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME46341 Issued in FL
Practice address
2467 Enterprise Rd Ste a
Clearwater, FL 33763-1724
Phone
(727) 791-1411
Fax
(727) 791-1419
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X 46341 FL
Dermatology Physician 207N00000X ME46341 FL Primary

Addresses

Primary practice location

2467 Enterprise Rd Ste a
Clearwater, FL 33763-1724

Mailing address

2467 Enterprise Rd
Ste a
Clearwater, FL 33763-1724
Phone (727) 791-1411

Other identifiers 3

IdentifierTypeStateIssuer
1114039732OtherNPI
79962OtherFLBLUE CROSS/BLUE SHIELD
K1008OtherPTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100726000250 FL Practitioner - DermatologyPractitioner - Micrographic Dermatologic Surgery (MDS) 0143393306 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
DermatologyAlso: Micrographic Dermatologic Surgery (MDS)
Education
Emory University School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suncoast Skin SolutionsGroup PAC ID 7416018221, 102 clinicians

Practice addresses (Care Compare)

2467 Enterprise Rd
Suite a
Clearwater, FL 33763-1724
Phone (813) 321-1786

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions520
Skin biopsy166

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46341FLMDMOHS-Micrographic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Suncoast Skin Solutions Dermatology CurrentSince Jan 3, 2022 Accepting new patients
Douglas K Pierce MD PA Past Accepting new patients

Locations

2467 Enterprise Rd
Ste A
Clearwater, FL 33763
Phone (727) 350-2949

4651 Van Dyke Rd
Lutz, FL 33558

11200 Seminole Blvd
Ste 205
Seminole, FL 33778
Phone (727) 820-1786

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: susan.roper@suncoastskin.emadirect.md

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1114039732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2467 ENTERPRISE RD",
            "address_2": "STE A",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337631724",
            "telephone_number": "727-791-1411",
            "fax_number": "727-791-1419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2467 ENTERPRISE RD STE A",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337631724",
            "telephone_number": "727-791-1411",
            "fax_number": "727-791-1419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROPER",
        "first_name": "SUSAN",
        "middle_name": "ST.CLAIR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "46341",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME46341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1114039732",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "79962",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "K1008",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.