Individual provider Active NPI

Marissa I-Fang Su, MD

  • Internal Medicine Physician
  • Honolulu, HI
National Provider Identifier
1245891712
Registry record updated Jun 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
7792 Issued in HI
Practice address
1356 Lusitana St FL 7
Honolulu, HI 96813-2409
Phone
(808) 586-2890
NPI assigned
Jun 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2019

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 7792 HI Primary

Addresses

Primary practice location

1356 Lusitana St FL 7
Honolulu, HI 96813-2409

Mailing address

1356 Lusitana St FL 7
Honolulu, HI 96813-2409

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250721000605 IN Practitioner - Pulmonary Disease 3173904893 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Good Samaritan Hospital Physician Services, IncGroup PAC ID 3971671330, 143 clinicians

Practice addresses (Care Compare)

520 S 7TH St
Vincennes, IN 47591-1038
Phone (812) 885-3280

Hospital & facility affiliations

  • Good Samaritan Hospital Hospital, Vincennes, IN, CCN 150042
  • Crawford Memorial Hospital Hospital, Robinson, IL, CCN 141343
  • Deaconess Hospital Inc Hospital, Evansville, IN, CCN 150082

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7792HIMDInternal Medicine Physician
13874GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital CurrentSince Aug 1, 2025 Accepting new patients
Good Samaritan Hospital Physician Services, Inc Internal Medicine CurrentSince Aug 1, 2025 Accepting new patients
Good Samaritan Hospital Physician Services Inc. Past Accepting new patients

Locations

520 S 7th St
Vincennes, IN 47591
Phone (812) 885-3280

1160 E Saint Clair St
Vincennes, IN 47591
Phone (812) 882-1064

Organizations & group practices 3

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 6

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": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1245891712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1356 LUSITANA ST FL 7",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1356 LUSITANA ST FL 7",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132409",
            "telephone_number": "808-586-2890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "MARISSA",
        "middle_name": "I-FANG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-25",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "7792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.