Active NPI
Suzann Moore, CSFA
- Surgical Technologist
- Indianapolis, IN
National Provider Identifier
1265443402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- 83030
- Practice address
- 355 W 16TH St
Suite 5100
Indianapolis, IN 46202-2207 - Phone
- (317) 393-1300
- Fax
- (317) 924-8472
- NPI assigned
- Aug 11, 2006
- 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 |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | |||
| Surgical Technologist | 246ZS0410X | 83030 | IN | Primary |
Addresses
Primary practice location
355 W 16TH St
Suite 5100
Indianapolis, IN 46202-2207
Mailing address
8333 Naab Rd
Ste 250
Indianapolis, IN 46260-5924
Phone (317) 393-1300
Other practice location 1
8450 Northwest Blvd
Indianapolis, IN 46278-1381
Phone (317) 802-2000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 83030 | Other | IN | CST/CFA |
| 000000592199 | Other | IN | ANTHEM BLUE CROSS AND BLUE SHIELD |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83030 | IN | MD | Surgical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559779200000",
"number": "1265443402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8333 NAAB RD",
"address_2": "STE 250",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462605924",
"telephone_number": "317-393-1300",
"fax_number": "317-396-1346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "355 W 16TH ST",
"address_2": "SUITE 5100",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462022207",
"telephone_number": "317-393-1300",
"fax_number": "317-924-8472"
}
],
"practiceLocations": [
{
"address_1": "8450 Northwest Blvd",
"address_purpose": "LOCATION",
"city": "Indianapolis",
"state": "IN",
"postal_code": "462781381",
"country_code": "US",
"telephone_number": "317-802-2000",
"fax_number": "317-802-2170",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOORE",
"first_name": "SUZANN",
"credential": "CSFA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-11",
"last_updated": "2019-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "IN",
"license": "83030",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CST/CFA",
"identifier": "83030",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS AND BLUE SHIELD",
"identifier": "000000592199",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.