Active NPI
Suzett Moffitt
- In Home Supportive Care Agency
- Indianapolis, IN
National Provider Identifier
1295147718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- In Home Supportive Care Agency
- License
- 14-013067-1
- Practice address
- 2401 N Tibbs Ave
Indianapolis, IN 46222-2457 - Phone
- (317) 755-7664
- Fax
- (317) 955-7567
- NPI assigned
- Jun 2, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 14-013067-1 | IN | |
| In Home Supportive Care Agency | 253Z00000X | 14-013067-1 | IN | Primary |
Addresses
Primary practice location
2401 N Tibbs Ave
Indianapolis, IN 46222-2457
Mailing address
2401 N Tibbs Ave
Indianapolis, IN 46222-2457
Phone (317) 755-7664
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14-013067-1 | Other | IN | INDIANA STATE DEPARTMENT OF HEALTH |
| 201172830A | Other | IN | INDIANA STATE DEPARTMENT OF HEALTH |
| A0H1301OSSTKEAN | Other | IN | CMS EHR CERTIFICATION ID |
| 829814297 | Other | IN | CCR REGISTRATION |
| 76110000 | Other | IN | DEPARTMENT OF ADMINISTRATION |
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 |
|---|---|---|---|
| 14-013067-1 | IN | MD | In Home Supportive Care Agency |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suzy Q Service Cororation | In Home Supportive Care | Current | Accepting new patients |
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 and National Provider Directory roles.
-
dba Suzy Q Cleaning Service LLC & Personal Service Agency
- In Home Supportive Care Agency
- Indianapolis, IN
- NPI 1780025163
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582156800000",
"number": "1295147718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 N TIBBS AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462222457",
"telephone_number": "317-755-7664",
"fax_number": "317-955-7567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 N TIBBS AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462222457",
"telephone_number": "317-755-7664",
"fax_number": "317-955-7567"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOFFITT",
"first_name": "SUZETT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-02",
"last_updated": "2020-02-20",
"certification_date": "2020-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "IN",
"license": "14-013067-1",
"primary": false
},
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": "IN",
"license": "14-013067-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIANA STATE DEPARTMENT OF HEALTH",
"identifier": "14-013067-1",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIANA STATE DEPARTMENT OF HEALTH",
"identifier": "201172830A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CMS EHR CERTIFICATION ID",
"identifier": "A0H1301OSSTKEAN",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CCR REGISTRATION",
"identifier": "829814297",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF ADMINISTRATION",
"identifier": "76110000",
"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 Feb 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.