Susan Elizabeth Gillis, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A172110 Issued in CA

Practice address

25500 Rancho Niguel Rd Ste 110
Laguna Niguel, CA 92677-7373

Phone

(949) 448-8821

NPI assigned

May 15, 2015

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Coastal Kids, a Professional Medical Corporation

  • Pediatrics Physician
  • Newport Beach, CA
  • NPI 1740311737

  Multi-Specialty

  NPD (past)
• Grossmont Hospital Corporation

  • General Acute Care Hospital
  • La Mesa, CA
  • NPI 1528041811

  Multi-Specialty

  NPD (past)
• Mission Hospital Regional Medical Center

  • Rehabilitation Hospital
  • Mission Viejo, CA
  • NPI 1003956913
  NPD (past)
• Rady Children'S Hospital San Diego

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Diego, CA
  • NPI 1851303994
  NPD (past)
• Providence Health & Services-Wa

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Everett, WA
  • NPI 1033360144

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1431648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1215315858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 PASEO VILLAGE WAY APT 1321",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303232",
            "telephone_number": "260-241-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25500 RANCHO NIGUEL RD STE 110",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926777373",
            "telephone_number": "949-448-8821"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "408 Canal View Way",
            "address_2": "Apt D",
            "address_purpose": "LOCATION",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46202",
            "country_code": "US",
            "telephone_number": "260-241-5700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 Childrens Ln",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235071910",
            "country_code": "US",
            "telephone_number": "757-668-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6942 University Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "LA Mesa",
            "state": "CA",
            "postal_code": "919425963",
            "country_code": "US",
            "telephone_number": "619-698-2184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLIS",
        "first_name": "SUSAN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-15",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A172110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parvin Ghassemian
• Dina Rafik Ghobrial, DDS
• Maryam Ghorbani Salestani
• Badr Khalil Ghumrawi, MD
• James Gilliland
• Maria Nerina Girasol, MSN, RN, AG-CNS
• Richard James Glassock, M.D.
• Jacqueline Judith Gleason, M.S.P.T.
• Glenn P. Frial, DDS, Ms, a Professional Corporation
• Brittany C Glenn, DO

• Pediatrics Physician in Laguna Niguel, CA
• Providers in Laguna Niguel, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.