Individual provider Active NPI

Susan B Oh, M.D.

  • Dermatology Physician
  • Braselton, GA
National Provider Identifier
1194112979
Registry record updated Jul 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
81800 Issued in GA
Practice address
1515 River PL Ste 300
Braselton, GA 30517-5605
Phone
(770) 972-4845
Fax
(770) 972-0358
NPI assigned
Apr 20, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 81800 GA Primary

Addresses

Primary practice location

1515 River PL Ste 300
Braselton, GA 30517-5605

Mailing address

2383 Pate St N
Snellville, GA 30078-3250
Phone (770) 972-4845

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20190703001740 GA Practitioner - Dermatology 8921332412 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gwinnett Dermatology PC D/B/a Georgia Dermatology Partners Dermatology CurrentSince Jul 29, 2019 Accepting new patients

Locations

1515 River Pl
Ste 300
Braselton, GA 30517
Phone (770) 972-4845

3929 Peachtree Rd NE
Ste 300
Brookhaven, GA 30319
Phone (770) 972-4845

2383 Pate St N
Snellville, GA 30078
Phone (770) 972-4845

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1429488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1194112979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2383 PATE ST N",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300783250",
            "telephone_number": "770-972-4845",
            "fax_number": "770-972-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 RIVER PL STE 300",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305175605",
            "telephone_number": "770-972-4845",
            "fax_number": "770-972-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OH",
        "first_name": "SUSAN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-20",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "81800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Braselton, GA

Sources for this page

Verify at the official NPI Registry.