Susan Mizelle, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

1883 Issued in TN

Practice address

400 N State of Franklin Rd
Johnson City, TN 37604-6035

Phone

(423) 431-6111

NPI assigned

Sep 20, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Susan Salyer Former name

Medicare fee-for-service enrollment

Enrolled in TN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Blue Ridge Medical Management Corporation

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833
  Medicare reassignment
• Tri-Cities Regional Emergency Physicians, PC

  • Emergency Medicine Physician
  • Johnson City, TN
  • NPI 1063950046
  Medicare reassignment
• Blue Ridge Medical Management Corporation

  • Family Medicine Physician
  • Erwin, TN
  • NPI 1588128755
  NPD
• Blue Ridge Medical Management Corporation

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1982553756
  NPD
• Blue Ridge Medical Management Corporation

  • Cardiovascular Disease Physician
  • Johnson City, TN
  • NPI 1740227131

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1295043602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 W MOUNTAIN VIEW RD",
            "address_2": "APARTMENT 1301",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042523",
            "telephone_number": "423-276-4033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N STATE OF FRANKLIN RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046035",
            "telephone_number": "423-431-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIZELLE",
        "first_name": "SUSAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-20",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1883",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "1883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "SALYER",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jill A Mitchell, FNP-BC
• Kelly Brooke Mitchell, ASSOCIATE DEGREE INT
• Linda Lee Mitchell, ED.D.
• Victoria S. Mitchell, RN
• Justin T Mizelle, PA-C
• Dianna Nicole Mock, APRN
• Homayoun Modarresifar, MD
• Randy D. Modglin, D.C.
• Abdallah Mohamed, MD
• Khalid Mohamed Hamadelneel Mohamed, MD

• Surgical Physician Assistant in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Surgical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.