Individual provider Active NPI

Susan M Berry, M.D.

  • Pediatric Ophthalmology and Strabismus Specialist Physician
  • Live Oak, TX
National Provider Identifier
1154429868
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Ophthalmology and Strabismus Specialist PhysicianTaxonomy code 207WX0110X
License
H1990 Issued in TX
Practice address
11601 Toepperwein Rd
Live Oak, TX 78233-3147
Phone
(210) 946-2020
NPI assigned
Sep 20, 2006
Last updated
Mar 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X H1990 TX
Pediatric Ophthalmology and Strabismus Specialist Physician 207WX0110X H1990 TX Primary

Addresses

Primary practice location

11601 Toepperwein Rd
Live Oak, TX 78233-3147

Mailing address

11601 Toepperwein Rd
Live Oak, TX 78233-3147
Phone (210) 946-2020

Other identifiers 1

IdentifierTypeStateIssuer
126420201MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20060503000350 TX Practitioner - Ophthalmology 2860402989 Practice locations: Live Oak, TX

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Texas Southwestern Medical School at Dallas, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11601 Toepperwein Rd
Live Oak, TX 78233-3147
Phone (210) 946-2020

11601 Toepperwein Rd
Live Oak, TX 78233-3403

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
H1990TXMDOphthalmology Physician

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1154429868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11601 TOEPPERWEIN RD",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333147",
            "telephone_number": "210-946-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11601 TOEPPERWEIN RD",
            "city": "LIVE OAK",
            "state": "TX",
            "postal_code": "782333147",
            "telephone_number": "210-946-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "SUSAN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "H1990",
            "primary": false
        },
        {
            "code": "207WX0110X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist",
            "state": "TX",
            "license": "H1990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126420201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Live Oak, TX

Sources for this page

Verify at the official NPI Registry.