Individual provider Active NPI

Susan D. Brown, LPN

  • Licensed Practical Nurse
  • Madison, WI
National Provider Identifier
1316087679
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
14260031 Issued in WI
Practice address
3113 E Washington Ave
Madison, WI 53704-4330
Phone
(608) 242-0220
NPI assigned
Feb 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 14260031 WI Primary

Addresses

Primary practice location

3113 E Washington Ave
Madison, WI 53704-4330

Mailing address

508 Prospect Ave
Portage, WI 53901-2017
Phone (608) 742-1883

Other identifiers 2

IdentifierTypeStateIssuer
14260031OtherWVLPN LICENSE NUMBER
42016400MedicaidWI

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

LicenseStateTypeSpecialty
14260031WIMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Health Services Past 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.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1316087679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 PROSPECT AVE",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539012017",
            "telephone_number": "608-742-1883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3113 E WASHINGTON AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537044330",
            "telephone_number": "608-242-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "SUSAN",
        "middle_name": "D.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "14260031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPN LICENSE NUMBER",
            "identifier": "14260031",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42016400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.