Individual provider Active NPI

Susan G Hagstrom, M.D.

  • Internal Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1235112061
Registry record updated Sep 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
23438 Issued in AZ
Practice address
5779 E Mayo Blvd
Phoenix, AZ 85054
Phone
(480) 301-8000
NPI assigned
Nov 25, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 23438 AZ Primary

Addresses

Primary practice location

5779 E Mayo Blvd
Phoenix, AZ 85054

Mailing address

5779 E Mayo Blvd
Phoenix, AZ 85054-4502
Phone (480) 301-8000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address shagstrom394634@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20100222000617 AZ Practitioner - Internal Medicine 5799829271 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Geisel School of Medicine at Dartmouth, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mayo Clinic ArizonaGroup PAC ID 7012829930, 1,618 clinicians

Practice addresses (Care Compare)

13400 E Shea Blvd
Scottsdale, AZ 85259-5404
Phone (480) 301-8000

13737 N 92ND St
Thunderbird Primary
Scottsdale, AZ 85260-7434
Phone (480) 860-4800

5701 E Mayo Blvd
Phoenix, AZ 85054-4502
Phone (480) 342-4200

5777 E Mayo Blvd
Phoenix, AZ 85054-4502

5779 E Mayo Blvd
Speciality Building
Phoenix, AZ 85054-4502
Phone (480) 301-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.47 of 100Reported as group
Quality
78.27
Promoting interoperability
100
Improvement activities
40
Cost
76.62

Merit-based Incentive Payment System (MIPS)

Final score
40.82 of 100Reported as group
Quality
9.1
Promoting interoperability
100
Improvement activities
0
Cost
43.64

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
23438AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Arizona CurrentSince Dec 1, 1997 Accepting new patients
Mayo Clinic Arizona CurrentSince Dec 1, 1997 Accepting new patients

Locations

5779 E Mayo Blvd
Phoenix, AZ 85054
Phone (480) 342-0865

13400 E Shea Blvd
Scottsdale, AZ 85259

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1235112061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5779 E MAYO BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850544502",
            "telephone_number": "480-301-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5779 E MAYO BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85054",
            "telephone_number": "480-301-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGSTROM",
        "first_name": "SUSAN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-25",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "23438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shagstrom394634@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "5779 E Mayo Blvd",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "85054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.