Active NPI
Susan Jill Hazel, PMHNP
- Psychiatric/Mental Health Nurse Practitioner
- Lake Oswego, OR
National Provider Identifier
1255453437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 000036739N6
- Practice address
- 15100 Boones Ferry Rd
#700
Lake Oswego, OR 97035-3469 - Phone
- (503) 330-5092
- Fax
- (503) 892-3129
- NPI assigned
- Apr 6, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 000036739N6 | OR | Primary |
Addresses
Primary practice location
15100 Boones Ferry Rd
#700
Lake Oswego, OR 97035-3469
Mailing address
PO Box 13510
Mhpbs
Portland, OR 97213
Phone (503) 249-0181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2016 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255453437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13510",
"address_2": "MHPBS",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97213",
"telephone_number": "503-249-0181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15100 BOONES FERRY RD",
"address_2": "#700",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970353469",
"telephone_number": "503-330-5092",
"fax_number": "503-892-3129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAZEL",
"first_name": "SUSAN",
"middle_name": "JILL",
"credential": "PMHNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "OR",
"license": "000036739N6",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Oswego, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.