Susannah Hancock, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

54459 Issued in ID

Practice address

1189 Red Robin Ave
Ammon, ID 83401-5747

Phone

(619) 602-4520

NPI assigned

Oct 17, 2016

Last updated

Apr 16, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, TX2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sleep Reset Medical Group of California PCGroup PAC ID 7719400191, 5 clinicians

Sleep Reset Medical Group PAGroup PAC ID 9638699291, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sleep Reset Medical Group of California PC

  • Sleep Medicine (Internal Medicine) Physician
  • San Francisco, CA
  • NPI 1659183622
  Medicare reassignment Care Compare group NPD
• Sleep Reset Medical Group PA

  • Sleep Medicine (Internal Medicine) Physician
  • San Francisco, CA
  • NPI 1003626797

  TX

  Medicare reassignment Care Compare group NPD
• Fortify Optimal Health

  • Family Medicine Physician
  • Ammon, ID
  • NPI 1437945391
  NPD Authorized official

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1164973053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "784 SOUTH CLEAR LOOP STE R",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "83854",
            "telephone_number": "619-602-4520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1189 RED ROBIN AVE",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834015747",
            "telephone_number": "619-602-4520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANCOCK",
        "first_name": "SUSANNAH",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-17",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95006211",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "54459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Avery C Hall, PA-C
• Brian Kendall Hall, DPT
• Marianne Hammer
• Brett L Hampton, LCSW
• Allison Marie Hancock, B.A
• Gabrielle Monson Hannon, LAMFT
• Jeana M Hansen
• Paige Hansen, PHARMD
• Todd Carlton Hansen
• Kamlyn Harker, PA

• Family Nurse Practitioner in Ammon, ID
• Providers in Ammon, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.