Active NPI
Susan Marie Moore-Riesbeck, D.O.
- Family Medicine Physician
- Elkhart, IN
National Provider Identifier
1215090378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 02001290A
- Practice address
- 28070 County Road 24
Elkhart, IN 46517-9717 - Phone
- (574) 273-8053
- Fax
- (574) 273-8056
- NPI assigned
- Dec 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 02001290A | IN | Primary |
Addresses
Primary practice location
28070 County Road 24
Elkhart, IN 46517-9717
Mailing address
PO Box 175
Granger, IN 46530-0175
Phone (574) 273-8053
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100366000 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | SusanMooreRiesbeck@143556.advancedmd-direct.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Geriatric Medicine
- Education
- At Still University of Health Sciences, College of Osteo Med, Kirksville, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
28070 County Rd
Suite 24
Elkhart, IN 46517-9717
Phone (574) 273-8053
Hospital & facility affiliations
- Southerncare South Bend
- Goshen Home Care and Hospice
- Community Hospital of Bremen Inc
- Hubbard Hill Estates Inc
- Southfield Village
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02001290A | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SMR Services LLC | Current | Accepting new patients | |
| Clay Township Clinic LLC | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- susanmooreriesbeck@143556.advancedmd-direct.com
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.
-
- Geriatric Medicine (Family Medicine) Physician
- Elkhart, IN
- NPI 1174178701
-
- Family Medicine Physician
- South Bend, IN
- NPI 1659555142
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Bremen, IN
- NPI 1568417004
-
- Community Based Hospice Care Agency
- Goshen, IN
- NPI 1235191032
-
- Community Based Hospice Care Agency
- Mishawaka, IN
- NPI 1740228832
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604016000000",
"number": "1215090378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 175",
"city": "GRANGER",
"state": "IN",
"postal_code": "465300175",
"telephone_number": "574-273-8053",
"fax_number": "574-273-8056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28070 COUNTY ROAD 24",
"city": "ELKHART",
"state": "IN",
"postal_code": "465179717",
"telephone_number": "574-273-8053",
"fax_number": "574-273-8056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE-RIESBECK",
"first_name": "SUSAN",
"middle_name": "MARIE",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-19",
"last_updated": "2020-10-30",
"certification_date": "2020-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "02001290A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100366000",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "SusanMooreRiesbeck@143556.advancedmd-direct.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "28070 County Road 24",
"city": "Elkhart",
"state": "IN",
"country_code": "US",
"postal_code": "465179717",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; 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.