NPIMap

Individual provider Active NPI

Susan Kathleen Dubois, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Austin, TX
National Provider Identifier
1114091675
Registry record updated Jun 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
H6178 Issued in TX
Practice address
2901 Montopolis Dr
Austin, TX 78741-6411
Phone
(512) 978-9901
Fax
(512) 901-9765
NPI assigned
Nov 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X H6178 TX Primary

Addresses

Primary practice location

2901 Montopolis Dr
Austin, TX 78741-6411

Mailing address

2901 Montopolis Dr
Austin, TX 78741-6411
Phone (512) 978-9901

Other identifiers 4

IdentifierTypeStateIssuer
147296102MedicaidTX
8U0684OtherOLD BLUE CROSS #
743009528OtherGROUP TAX ID
8X7501OtherNEW BLUE CROSS #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150226000852 TX Order and Referring Only - EndocrinologyPractitioner - Endocrinology 2466485826

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
University of Texas Medical School at Houston, 1988
Medicare assignment
May accept Medicare assignment
Group practices
Central Texas Community Health CentersGroup PAC ID 5395802151, shared by 33 NPIs, 165 clinicians

Practice addresses (Care Compare)

1210 W Braker LN
Austin, TX 78758-3801
Phone (512) 978-9800

2901 Montopolis Dr
Austin, TX 78741-6411
Phone (512) 978-9955

Hospital & facility affiliations

  • Ascension Seton Medical Center Austin Hospital, Austin, TX, CCN 450056

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
H6178TXMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Seton Past Accepting new patients
Simona Scumpia MD PA Endocrinology, Diabetes & Metabolism PastSince Feb 4, 2002 Accepting new patients
Utmb Austin - Initiatives Past Accepting new patients
Central Texas Community Health Centers Past Accepting new patients
University of Texas Medical Branch, Austin Initiatives at Utmb Past Accepting new patients

Organizations & group practices 5

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465516800000",
    "number": "1114091675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 MONTOPOLIS DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787416411",
            "telephone_number": "512-978-9901",
            "fax_number": "512-901-9765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 MONTOPOLIS DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787416411",
            "telephone_number": "512-978-9901",
            "fax_number": "512-901-9765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBOIS",
        "first_name": "SUSAN",
        "middle_name": "KATHLEEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-17",
        "last_updated": "2016-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "TX",
            "license": "H6178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "147296102",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OLD BLUE CROSS #",
            "identifier": "8U0684",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP TAX ID",
            "identifier": "743009528",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW BLUE CROSS #",
            "identifier": "8X7501",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.