Individual provider Active NPI

Susan Anne Siekierski, PT

  • Physical Therapist
  • Indianapolis, IN
National Provider Identifier
1366518425
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070007773 Issued in IL
Practice address
7209 N Shadeland Ave
Indianapolis, IN 46250-2021
Phone
(773) 467-5669
NPI assigned
Nov 28, 2006
Last updated
May 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05013180A IN
Physical Therapist 225100000X 070007773 IL Primary

Addresses

Primary practice location

7209 N Shadeland Ave
Indianapolis, IN 46250-2021

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other practice location 1

1002 Wishard Blvd Ste 2021
Indianapolis, IN 46202-4164
Phone (317) 944-8868

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ssiekierski@direct.iuhealth.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240521003013 IN Practitioner - Physical Therapist in Private Practice 4688016702 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070007773ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Iu Health Medical Group, LLC CurrentSince Oct 1, 2025 Accepting new patients
Indiana University Health, Inc CurrentSince Apr 15, 2024 Accepting new patients
Iu Health Medical Group Riley Specialists, LLC CurrentSince Jan 1, 2026 Accepting new patients

Locations

2242 Reliable Pkwy
Chicago, IL 60686

1002 Wishard Blvd
Indianapolis, IN 46202
Phone (317) 692-2300

1002 Wishard Blvd
Ste 2021
Indianapolis, IN 46202
Phone (317) 944-8167

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

705 Riley Hospital Dr
Indianapolis, IN 46202
Phone (317) 274-4779

2209 John R Wooden Dr
Martinsville, IN 46151
Phone (765) 342-3364

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1366518425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7209 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502021",
            "telephone_number": "773-467-5669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1002 Wishard Blvd Ste 2021",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462024164",
            "country_code": "US",
            "telephone_number": "317-944-8868",
            "fax_number": "317-944-1141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIEKIERSKI",
        "first_name": "SUSAN",
        "middle_name": "ANNE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05013180A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070007773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ssiekierski@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1002 Wishard Blvd Ste 2021",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462024164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.