Active NPI
Susan J Sam
- Family Nurse Practitioner
- Grosse Pointe, MI
National Provider Identifier
1225565377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 4704257975
- Practice address
- 468 Cadieux Rd
Grosse Pointe, MI 48230-1507 - Phone
- (313) 473-1605
- NPI assigned
- May 20, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical-Surgical Registered Nurse | 163WM0705X | 4704257975 | MI | |
| Family Nurse Practitioner | 363LF0000X | 4704257975 | MI | Primary |
Addresses
Primary practice location
468 Cadieux Rd
Grosse Pointe, MI 48230-1507
Mailing address
7146 N Central Park
Shelby TWP, MI 48317-2388
Phone (586) 722-3339
Other practice location 1
44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-5000
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ssam613473@direct.beaumont.edu |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704257975 | MI | MD | Medical-Surgical Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609891200000",
"number": "1225565377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7146 N CENTRAL PARK",
"city": "SHELBY TWP",
"state": "MI",
"postal_code": "483172388",
"telephone_number": "586-722-3339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "468 CADIEUX RD",
"city": "GROSSE POINTE",
"state": "MI",
"postal_code": "482301507",
"telephone_number": "313-473-1605"
}
],
"practiceLocations": [
{
"address_1": "44201 Dequindre Rd",
"address_purpose": "LOCATION",
"city": "Troy",
"state": "MI",
"postal_code": "480851117",
"country_code": "US",
"telephone_number": "248-964-5000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SAM",
"first_name": "SUSAN",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-20",
"last_updated": "2021-01-06",
"certification_date": "2021-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "163WM0705X",
"taxonomy_group": "",
"desc": "Registered Nurse, Medical-Surgical",
"state": "MI",
"license": "4704257975",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MI",
"license": "4704257975",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ssam613473@direct.beaumont.edu",
"affiliation": "N",
"address_1": "468 Cadieux Rd",
"city": "Grosse Pointe",
"state": "MI",
"country_code": "US",
"postal_code": "482301507",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Grosse Pointe, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.