Susan Mims
Individual provider Active NPI Physician Assistant · Cuero, TX
NPI 1124473616 · NPPES record last updated Sep 29, 2021
Key facts
- NPI
- 1124473616
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 2500 N Esplanade St
Suite 101
Cuero, TX 77954-4723 - Phone
- (361) 275-2381
- NPI assigned
- May 3, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 22
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dewitt Medical District
Practice addresses (Care Compare)
113 W Main St
Kenedy Family Practice
Kenedy, TX 78119-2717
Phone (830) 583-0612
139 W Franklin St
Goliad, TX 77963-4281
Phone (361) 645-8235
2500 N Esplanade St
Cuero, TX 77954-4723
2500 N Esplanade St
Suite 102
Cuero, TX 77954-4727
Phone (361) 275-3466
2550 N Esplanade St
Cuero, TX 77954-4736
Hospital & facility affiliations
- Cuero Home Health Inc
- Cuero Regional Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161214000837 | TX | Practitioner - Physician Assistant | 1254611056 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dewitt Medical District | Current |
Accepting new patients | |
| Dewitt Medical District | Current |
Accepting new patients | |
| Citizens Medical Center County of Victoria | Past | Accepting new patients | |
| Dewitt Medical District | Past | Accepting new patients |
Locations
2500 N Esplanade St
Ste 101
Cuero, TX 77954
Phone (361) 275-2381
2500 N Esplanade St
Ste 102
Cuero, TX 77954
Phone (361) 275-3466
2550 N Esplanade St
Cuero, TX 77954
Phone (361) 275-0532
139 W Franklin St
Goliad, TX 77963
Phone (361) 645-8235
113 W Main St
Kenedy, TX 78119
Phone (830) 583-0612
508 N Riedel St
Yorktown, TX 78164
Phone (361) 564-3383
Interoperability endpoints
- susanmims@dmdclinic.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
2500 N Esplanade St
Suite 101
Cuero, TX 77954-4723
Mailing address
2500 N Esplanade St
Ste 102
Cuero, TX 77954-4727
Phone (361) 275-2381
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 365219001 | Medicaid | TX |
Other providers in Cuero, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.