Susan G Pak, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA14449 Issued in CA

Practice address

81 Highland Springs Ave
Suite 200
Beaumont, CA 92223

Phone

(951) 845-0313

Fax

(909) 796-4158

NPI assigned

May 24, 2006

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

Enrolled in CA

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

Interoperability endpoints

• Direct secure messaging: spak11077@epiclp.direct-ci.com

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.

• Beaver Medical Group P C

  dba Optum

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1649503319
  Medicare reassignment NPD
• Beaver Medical Group P C

  • Physical Therapist
  • Redlands, CA
  • NPI 1427090281
  NPD
• Diagnostic Imaging Services

  • Magnetic Resonance Imaging (MRI) Internal Medicine Physician
  • Metairie, LA
  • NPI 1699793166
  NPD (past)

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469059200000",
    "number": "1366497703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10069",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924230069",
            "telephone_number": "909-335-4188",
            "fax_number": "909-796-4158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 HIGHLAND SPRINGS AVE",
            "address_2": "SUITE 200",
            "city": "BEAUMONT",
            "state": "CA",
            "postal_code": "92223",
            "telephone_number": "951-845-0313",
            "fax_number": "909-796-4158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAK",
        "first_name": "SUSAN",
        "middle_name": "G",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2016-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA14449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OPA144490",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stevie Kristine Olney, O.D.
• Funmilayo Falese Olukanni
• Glenda Ediesca Ong, O.D.
• Alejandro Ortiz Gallardo
• Johanna Padilla
• Daniel C Park, D.D.S.
• Mo a Park, PHARM.D
• Diana A. Parra, CD/PDT (MG)
• Marissa Partee, CDAC
• Alyssa Paulson

• Physician Assistant in Beaumont, CA
• Providers in Beaumont, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; 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.