Kenny Susanto, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

38794 Issued in OK

Practice address

2000 S Wheeling Ave Ste 701
Tulsa, OK 74104-5647

Phone

(918) 748-7810

NPI assigned

Jul 2, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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

Neurology

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St. John Physicians, Inc.Group PAC ID 2567366495, 262 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St John Medical Center Hospital, Tulsa, OK, CCN 370114
• Ascension St John Jane Phillips Hospital, Bartlesville, OK, CCN 370018
• Ascension St John Broken Arrow Hospital, Broken Arrow, OK, CCN 370235
• St John Owasso Hospital, Owasso, OK, CCN 370227

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St. John Physicians, Inc.

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1336194406

  Neurology

  Medicare reassignment Care Compare group NPD
• St. John Physicians, Inc

  • Rural Health Clinic/Center
  • Barnsdall, OK
  • NPI 1033176367
  NPD
• St John Medical Center Inc

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1154417368
  NPD (past)

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

• Jane Phillips Memorial Medical Center, Inc.

  • General Acute Care Hospital
  • Bartlesville, OK
  • NPI 1215914254
  Care Compare affiliation
• Jane Phillips Memorial Medical Center, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Bartlesville, OK
  • NPI 1427428986
  Care Compare affiliation
• Owasso Medical Facility, Inc

  • General Acute Care Hospital
  • Owasso, OK
  • NPI 1144231432
  Care Compare affiliation
• St John Medical Center Inc

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1154417368
  Care Compare affiliation
• St John Medical Center Inc

  • Rehabilitation Hospital Unit
  • Tulsa, OK
  • NPI 1578656161
  Care Compare affiliation
• St. John Broken Arrow, Inc

  • General Acute Care Hospital
  • Broken Arrow, OK
  • NPI 1497988596
  Care Compare affiliation

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

{
    "created_epoch": "1467417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1255783270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 S WHEELING AVE STE 701",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S WHEELING AVE STE 701",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045647",
            "telephone_number": "918-748-7810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSANTO",
        "first_name": "KENNY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-02",
        "last_updated": "2022-06-27",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CT",
            "license": "1.065004",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "008863",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OK",
            "license": "38794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shay Nicole Surowiak, APRN
• Demetrius Surratt, RN, IBCLC
• Abdul Kader Saifuddin Surti, MD
• Susan C. Willard, DO, PLLC
• Susan S. Staudt, D.O., Inc
• Melissa Sustaita
• Kyle Suter
• Roshni Hemant Suthar
• Margaret Ann Sutherland
• Salley Sutmiller

• Neurology Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Neurology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; 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.