Iris Leyretana Sumatra, MA

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP-8112 Issued in OH

Practice address

900 Club Dr
Westerville, OH 43081-4909

Phone

(614) 899-2838

Fax

(614) 899-2876

NPI assigned

Jan 30, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/10687/brand/1/csg/1/fhir/r4

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.

• Children'S Center for Developmental Enrichment

  • Speech-Language Pathologist
  • Westerville, OH
  • NPI 1659556215
  NPD (past)
• Oakstone Health Center

  • Primary Care Clinic/Center
  • Westerville, OH
  • NPI 1942514344
  NPD (past)

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416009600000",
    "number": "1306983481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CLUB DR",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430814909",
            "telephone_number": "614-899-2838",
            "fax_number": "614-899-2876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 CLUB DR",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430814909",
            "telephone_number": "614-899-2838",
            "fax_number": "614-899-2876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMATRA",
        "first_name": "IRIS",
        "middle_name": "LEYRETANA",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2014-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OH",
            "license": "SP-8112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0094740",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Hwan Suh, M.D.
• Conor Sullivan
• Edward Mark Sullivan, MSW, LISW-S
• Jenna Sullivan
• Melissa Sullivan, RD
• Nicole Elizabeth Summers, LISW
• Summerville at Outlook Manor, LLC
• Morgan Rashelle Sumner, OTR
• Rachel Sunday, PHARMD
• Sustainers Healthcare LLC

• Speech-Language Pathologist in Westerville, OH
• Providers in Westerville, OH by specialty
• Speech-Language Pathologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.