Susanti Rahaju Ie, MD

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

0101244044 Issued in VA

Practice address

2001 Crystal Spring Ave SW
Suite 300
Roanoke, VA 24014-2462

Phone

(540) 985-8505

NPI assigned

Nov 29, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in VA

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

Specialty

Pulmonary DiseaseAlso: Internal Medicine

Education

Tulane University School of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Carilion Medical CenterGroup PAC ID 9830096585, 956 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carilion Medical Center Hospital, Roanoke, VA, CCN 490024
• Carilion New River Valley Medical Center Hospital, Christiansburg, VA, CCN 490042
• Carilion Franklin Memorial Hospital Hospital, Rocky Mount, VA, CCN 490089
• Sovah Health Danville Hospital, Danville, VA, CCN 490075

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sie995@direct.carilionclinic.org

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.

• Carilion Medical Center

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1730123472
  Medicare reassignment Care Compare group NPD
• Carilion Giles Community Hospital

  • Critical Access Hospital
  • Pearisburg, VA
  • NPI 1194718304
  Medicare reassignment NPD
• Carilion Healthcare Corporation

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1447206370
  Medicare reassignment NPD
• Carilion Rockbridge Community Hospital

  • Multi-Specialty Clinic/Center
  • Lexington, VA
  • NPI 1174636021
  Medicare reassignment NPD
• Carilion Giles Community Hospital

  • Durable Medical Equipment & Medical Supplies
  • Galax, VA
  • NPI 1639980493
  NPD
• Carilion Healthcare Corporation

  • Durable Medical Equipment & Medical Supplies
  • Blacksburg, VA
  • NPI 1407667256
  NPD
• Carilion Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Hardy, VA
  • NPI 1073324810
  NPD
• Carilion Medical Center

  • General Acute Care Hospital
  • Roanoke, VA
  • NPI 1033102942
  NPD (past)
• Northside Primary Care Professional Services,LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1922397553
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Carilion Franklin Memorial Hospital

  • General Acute Care Hospital
  • Rocky Mount, VA
  • NPI 1710970918
  Care Compare affiliation
• Carilion Medical Center

  • General Acute Care Hospital
  • Roanoke, VA
  • NPI 1033102942
  Care Compare affiliation
• Carilion New River Valley Medical Center

  • General Acute Care Hospital
  • Christiansburg, VA
  • NPI 1376536573
  Care Compare affiliation
• Danville Regional Medical Center LLC

  • General Acute Care Hospital
  • Martinsville, VA
  • NPI 1386720183
  Care Compare affiliation
• Danville Regional Medical Center, LLC

  • Rural Acute Care Hospital
  • Danville, VA
  • NPI 1154419737
  Care Compare affiliation

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491264000000",
    "number": "1215910781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 CRYSTAL SPRING AVE SW",
            "address_2": "SUITE 300",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240142462",
            "telephone_number": "540-985-8505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 CRYSTAL SPRING AVE SW",
            "address_2": "SUITE 300",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240142462",
            "telephone_number": "540-985-8505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IE",
        "first_name": "SUSANTI",
        "middle_name": "RAHAJU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-29",
        "last_updated": "2017-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "GA",
            "license": "050640",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "GA",
            "license": "050640",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "VA",
            "license": "0101244044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00927616A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "5791203",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "874218",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "4800175",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "290014160",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "0932200001",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1944925001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7024155",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Hyduke
• Stephanie Alejandra Hylton, LCSW
• Anne K Ickes, DO
• Michelle Ann Ickes, PH.D.
• Idoctorben LLC
• Obafemi Ayoola Ifelowo, MD
• Ignite Wellness Clinic PLLC
• Emeka Ikeakanam, DO
• Image Guided Pain Management, P.C.
• Image Guided Therapeutics, PC

• Pulmonary Disease Physician in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Pulmonary Disease Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; 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.

Verify at the official NPI Registry.