Susrutha Thanam, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

Q2860 Issued in TX

Practice address

4110 Guadalupe St
Austin State Hospital
Austin, TX 78751-4223

Phone

(512) 419-2148

Fax

(512) 419-2163

NPI assigned

Mar 25, 2011

Last updated

Oct 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Psychiatry

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Denton County MHMR CenterGroup PAC ID 0547159329, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Denton County MHMR Center

  • Psychiatry Physician
  • Denton, TX
  • NPI 1578551347
  Medicare reassignment Care Compare group NPD
• Health and Human Services Commission

  dba Rio Grande State Center

  • Clinical Neuropsychologist
  • Harlingen, TX
  • NPI 1356414692

  Psychiatry

  Medicare reassignment NPD
• Denton County MHMR Center

  • Family Medicine Physician
  • Denton, TX
  • NPI 1932524824
  NPD
• Health and Human Services Commission

  dba Austin State Hospital

  • Clinical Neuropsychologist
  • Austin, TX
  • NPI 1003823030

  Psychiatry

  NPD
• Health and Human Services Commission

  dba Big Spring State Hospital

  • Psychiatric Hospital
  • Big Spring, TX
  • NPI 1881600682
  NPD

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

{
    "created_epoch": "1301011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1174822415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 GUADALUPE ST",
            "address_2": "AUSTIN STATE HOSPITAL",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787514223",
            "telephone_number": "512-419-2148",
            "fax_number": "512-419-2163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 GUADALUPE ST",
            "address_2": "AUSTIN STATE HOSPITAL",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787514223",
            "telephone_number": "512-419-2148",
            "fax_number": "512-419-2163"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2519 Scripture St",
            "address_purpose": "LOCATION",
            "city": "Denton",
            "state": "TX",
            "postal_code": "762012324",
            "country_code": "US",
            "telephone_number": "940-381-5000",
            "fax_number": "940-566-9072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THANAM",
        "first_name": "SUSRUTHA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-25",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "Q2860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew S Thai, O.D.
• Raj Kamlesh Thaker, D.M.D
• Semran Thamer, MD
• Todd A Thames, M.D.
• Daphne Thammasila, MA, CF-SLP
• Monika Sreeja Thangada, MD
• Manoj Thangam, M.D.
• Avinash Govind Thangirala, MD
• Omar Thannoun, CRNA
• Tariq E Thannoun, MD

• Psychiatry Physician in Austin, TX
• Providers in Austin, TX by specialty
• Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; 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.