Individual provider Active NPI

Susanne Mills Snider, CRNP

  • Family Nurse Practitioner
  • Northport, AL
National Provider Identifier
1124113394
Registry record updated Aug 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1-068376 Issued in AL
Practice address
2810 Lurleen Wallace Blvd
Northport, AL 35476-3249
Phone
(205) 373-6323
Fax
(205) 373-2544
NPI assigned
Oct 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 20, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1-068376 AL Primary

Addresses

Primary practice location

2810 Lurleen Wallace Blvd
Northport, AL 35476-3249

Mailing address

12792 Shelly Hughes Rd
Buhl, AL 35446-9164
Phone (205) 339-7165

Other identifiers 1

IdentifierTypeStateIssuer
104831MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080814000341 AL Practitioner - Nurse Practitioner 1355416041 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alabama Ear, Nose and Throat Specialists, LLCGroup PAC ID 7719104504, 5 clinicians

Practice addresses (Care Compare)

302 Merchants Walk
Suite 100
Tuscaloosa, AL 35406-2291
Phone (205) 523-9300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alabama Ear, Nose & Throat Specialists, LLC CurrentSince Dec 12, 2016 Accepting new patients

Locations

302 Merchants Walk
Ste 100
Tuscaloosa, AL 35406
Phone (205) 523-9300

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IHCHCA

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345420800000",
    "number": "1124113394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12792 SHELLY HUGHES RD",
            "city": "BUHL",
            "state": "AL",
            "postal_code": "354469164",
            "telephone_number": "205-339-7165",
            "fax_number": "205-373-2544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 LURLEEN WALLACE BLVD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354763249",
            "telephone_number": "205-373-6323",
            "fax_number": "205-373-2544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNIDER",
        "first_name": "SUSANNE",
        "middle_name": "MILLS",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2012-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-068376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104831",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northport, AL

Sources for this page

Verify at the official NPI Registry.