Active NPI
Suzanne Carol Ickes, R.D., LDN
- Registered Dietitian
- Bethlehem, PA
National Provider Identifier
1124236385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DN001762
- Practice address
- 2545 Schoenersville Rd
Lehighvalley Hospital -Clinical Nutrition
Bethlehem, PA 18017-7300 - Phone
- (484) 788-1255
- NPI assigned
- May 20, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DN001762 | PA | Primary |
Addresses
Primary practice location
2545 Schoenersville Rd
Lehighvalley Hospital -Clinical Nutrition
Bethlehem, PA 18017-7300
Mailing address
45 Warwick St
Suite 100
Bethlehem, PA 18018-2431
Phone (484) 788-1255
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2630546000 | Other | PA | INDEPENDENCE BLUE CROSS |
| 2630546000 | Other | PA | KEYSTONE HEALTH EAST |
| 001793520 | Other | PA | HIGHMARK BLUE SHIELD FOR FEDERAL EMPLOYEES |
| 2624640 | Other | PA | AETNA US HEALTHCARE |
| 2630546000 | Other | PA | PERSONALCHOICE/BLUECHOICE |
| 055154 | Other | PA | MEDICARE PROVIDER NUMBER |
| 001793520000 | Other | PA | AMERIHEALTH |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475020800000",
"number": "1124236385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 WARWICK ST",
"address_2": "SUITE 100",
"city": "BETHLEHEM",
"state": "PA",
"postal_code": "180182431",
"telephone_number": "484-788-1255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2545 SCHOENERSVILLE RD",
"address_2": "LEHIGHVALLEY HOSPITAL -CLINICAL NUTRITION",
"city": "BETHLEHEM",
"state": "PA",
"postal_code": "180177300",
"telephone_number": "484-788-1255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICKES",
"first_name": "SUZANNE",
"middle_name": "CAROL",
"name_prefix": "Mrs.",
"credential": "R.D., LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-20",
"last_updated": "2016-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "PA",
"license": "DN001762",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENCE BLUE CROSS",
"identifier": "2630546000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE HEALTH EAST",
"identifier": "2630546000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD FOR FEDERAL EMPLOYEES",
"identifier": "001793520",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA US HEALTHCARE",
"identifier": "2624640",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PERSONALCHOICE/BLUECHOICE",
"identifier": "2630546000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PROVIDER NUMBER",
"identifier": "055154",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH",
"identifier": "001793520000",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethlehem, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.