Individual provider Active NPI

Susan McNew Herrmann, MD

  • Anesthesiology Physician
  • Medford, OR
National Provider Identifier
1205867934
Registry record updated Oct 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
19221 Issued in OR
Practice address
2620-H East Barnett Road
Medford, OR 97504-8383
Phone
(541) 773-7273
Fax
(541) 773-2027
NPI assigned
Jul 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 19221 OR Primary

Addresses

Primary practice location

2620-H East Barnett Road
Medford, OR 97504-8383

Mailing address

2620-H East Barnett Road
Medford, OR 97504-8383
Phone (541) 773-7273

Other identifiers 1

IdentifierTypeStateIssuer
074583MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
19221ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Active Health Chiropractic, PC Past Accepting new patients
Anesthesia Associates of Medford PC Anesthesiology PastSince Jul 1, 2020 Accepting new patients

Organizations & group practices 2

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191369600000",
    "number": "1205867934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620-H EAST BARNETT ROAD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048383",
            "telephone_number": "541-773-7273",
            "fax_number": "541-773-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620-H EAST BARNETT ROAD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048383",
            "telephone_number": "541-773-7273",
            "fax_number": "541-773-2027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRMANN",
        "first_name": "SUSAN",
        "middle_name": "MCNEW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "19221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "074583",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.