Susan Pancoast Eddleman, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14169 Issued in MO

Practice address

204 S Main St
Rock Port, MO 64482-1532

Phone

(660) 744-5391

NPI assigned

Sep 27, 2005

Last updated

Jul 8, 2007By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dr. Susan P Eddleman

  • Dental Clinic/Center
  • Rock Port, MO
  • NPI 1518298231
  NPD (past) Authorized official

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184610909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 S MAIN ST",
            "address_2": "P. O. BOX 282",
            "city": "ROCK PORT",
            "state": "MO",
            "postal_code": "644821532",
            "telephone_number": "660-744-5391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 S MAIN ST",
            "city": "ROCK PORT",
            "state": "MO",
            "postal_code": "644821532",
            "telephone_number": "660-744-5391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDDLEMAN",
        "first_name": "SUSAN",
        "middle_name": "PANCOAST",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "14169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KANSAS CITY",
            "identifier": "13627011",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joanna Burke, PNP
• Richard Aron Burke, M.D.
• Community Hospital Association (Community Hospital-Fairfax)
• Pamala D Davis, RNCS,FNP
• Dr. Susan P Eddleman
• Jennifer L Long-Kelly, LPC
• Janell Ann Moore, LPC, LMHP
• Northwest Missouri Industries, Inc.
• Misty Marie Olberding, D.C.
• Pleasant View Healthcare LLC (Pleasant View)

• General Practice Dentistry in Rock Port, MO
• Providers in Rock Port, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.