Active NPI
Susan Schroeder, M.D.
- Procedural Dermatology Physician
- Colorado Springs, CO
National Provider Identifier
1366410920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Procedural Dermatology Physician
- License
- 25MA08824100
- Practice address
- 1259 Lake Plaza Dr Ste 270
Colorado Springs, CO 80906-3560 - Phone
- (719) 421-7132
- Fax
- (719) 639-7903
- NPI assigned
- Mar 9, 2006
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 40371 | CO | |
| Procedural Dermatology Physician | 207NS0135X | 25MA08824100 | NJ | Primary |
Addresses
Primary practice location
1259 Lake Plaza Dr Ste 270
Colorado Springs, CO 80906-3560
Mailing address
1259 Lake Plaza Dr Ste 270
Colorado Springs, CO 80906-3560
Phone (719) 421-7132
Other names 1
- Dr. Susan Schroeder Ellis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2020 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Perfect Skin PC | Specialist | Past | Accepting new patients |
| The Dermatology Group | Procedural Dermatology | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Specialist
- Colorado Springs, CO
- NPI 1609893783
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596240000000",
"number": "1366410920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1259 LAKE PLAZA DR STE 270",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809063560",
"telephone_number": "719-421-7132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1259 LAKE PLAZA DR STE 270",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809063560",
"telephone_number": "719-421-7132",
"fax_number": "719-639-7903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHROEDER",
"first_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-09",
"last_updated": "2020-08-01",
"certification_date": "2020-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CO",
"license": "40371",
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "NJ",
"license": "25MA08824100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "ELLIS",
"middle_name": "SCHROEDER",
"prefix": "DR.",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.