Individual provider Active NPI

Susie Ozetta Troxler, PH.D.

  • Psychologist
  • Greensboro, NC
National Provider Identifier
1184627614
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2790 Issued in NC
Practice address
3409 W Wendover Ave Ste E
Greensboro, NC 27407-1579
Phone
(336) 324-1610
NPI assigned
May 30, 2005
Last updated
Jun 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2790 NC Primary

Addresses

Primary practice location

3409 W Wendover Ave Ste E
Greensboro, NC 27407-1579

Mailing address

PO Box 41105
Greensboro, NC 27404-1105
Phone (336) 324-1610

Other practice location 1

3405 W Wendover Ave Ste F
Greensboro, NC 27407-1525
Phone (336) 324-1610

Other identifiers 2

IdentifierTypeStateIssuer
045R4OtherNCBLUE CROSS BLUE SHIELD
6000363MedicaidNC

Other names 1

  • Dr. Susie Ozetta Edwards Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050623000810 NC Practitioner - Clinical Psychologist 7810932407 Reassigns benefits to 1 organization
Practice locations: Greensboro, NC

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3409 W Wendover Ave
Suite E
Greensboro, NC 27407-1579
Phone (336) 323-1385

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2790NCMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Zephaniah Services PC Psychologist CurrentSince Apr 4, 2007 Accepting new patients
Dr. Susie O. Troxler Inc Psychologist Current Accepting new patients
Baker's Counseling and Mentoring Center, Inc Past Accepting new patients

Locations

3405 W Wendover Ave
Ste F
Greensboro, NC 27407
Phone (336) 323-1385

3409 W Wendover Ave
Ste E
Greensboro, NC 27407
Phone (336) 323-1385

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1117411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1184627614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41105",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274041105",
            "telephone_number": "336-324-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 W WENDOVER AVE STE E",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274071579",
            "telephone_number": "336-324-1610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3405 W Wendover Ave Ste F",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274071525",
            "country_code": "US",
            "telephone_number": "336-324-1610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TROXLER",
        "first_name": "SUSIE",
        "middle_name": "OZETTA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-05-30",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "2790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "045R4",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000363",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSIE",
            "last_name": "EDWARDS",
            "middle_name": "OZETTA",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.