Individual provider Active NPI

Susan Marra, PA

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1275579229
Registry record updated Mar 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
102866 Issued in NC
Practice address
3155 Maplewood Ave
Winston-Salem, NC 27103
Phone
(336) 794-4372
Fax
(336) 659-2379
NPI assigned
Jun 20, 2006
Last updated
Mar 7, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 102866 NC Primary

Addresses

Primary practice location

3155 Maplewood Ave
Winston-Salem, NC 27103

Mailing address

3010 Trenwest Dr
Winston Salem, NC 27103-3208
Phone (336) 970-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070530000205 NC Practitioner - Physician Assistant 7214034198 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Triad Radiology Associates PLLCGroup PAC ID 8729086194, 75 clinicians

Practice addresses (Care Compare)

3015 Maplewood Ave
Suite 200
Winston Salem, NC 27103-4075
Phone (336) 794-4188

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 718-3261

830 Rockford St
Mount Airy, NC 27030-5322
Phone (336) 719-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
102866NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Triad Radiology Associates PLLC CurrentSince Apr 1, 2007 Accepting new patients

Locations

830 Rockford St
Mount Airy, NC 27030
Phone (336) 719-7000

3010 Trenwest Dr
Winston Salem, NC 27103
Phone (336) 718-5844

3015 Maplewood Ave
Ste 200
Winston Salem, NC 27103
Phone (336) 794-4188

3155 Maplewood Ave
Winston Salem, NC 27103
Phone (336) 718-7980

Interoperability endpoints

  • Direct secure messaging: smarra144775@direct.novanthealth.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299456000000",
    "number": "1275579229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 TRENWEST DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033208",
            "telephone_number": "336-970-5000",
            "fax_number": "336-970-5298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3155 MAPLEWOOD AVE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-794-4372",
            "fax_number": "336-659-2379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARRA",
        "first_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-20",
        "last_updated": "2011-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.