Suzanne Michelle Fernbach, PA-C
Individual provider Active NPI Physician Assistant · Crittenden, KY
NPI 1366539652 · NPPES record last updated Aug 26, 2022
Key facts
- NPI
- 1366539652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA646 (KY)
- Practice address
- 405 Violet Rd
Crittenden, KY 41030-8956 - Phone
- (859) 903-0268
- Fax
- (859) 428-1444
- NPI assigned
- Oct 6, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 12
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- University of Kentucky College of Medicine, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Summit Medical Group Inc
Practice addresses (Care Compare)
1400 Grand Ave
Newport, KY 41071-2570
Phone (859) 301-5901
1640 Flossie Dr
Greendale, IN 47025-8424
Phone (855) 277-4230
2626 Alexandria Pike
Highland Heights, KY 41076-1530
Phone (859) 301-5901
300 Barnes Rd
Williamstown, KY 41097-9483
Phone (859) 824-8400
405 Violet Rd
Crittenden, KY 41030-8956
Phone (859) 301-5901
Hospital & facility affiliations
- St Elizabeth Edgewood
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.01 of 100
- Quality
- 86.02
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in KY, OH, IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090409000039 | KY | Practitioner - Physician Assistant | 5092610535 | Reassigns benefits to 1 organization |
| I20161129001608 | OH | Practitioner - Physician Assistant | 5092610535 | Reassigns benefits to 1 organization |
| I20200317000422 | IN | Practitioner - Physician Assistant | 5092610535 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA656 | KY | MD | Physician Assistant |
| PA646 | KY | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Medical Group, Inc | Physician Assistant | Current |
Accepting new patients |
Locations
204 Bridgeway St
Aurora, IN 47001
Phone (812) 926-3133
605 Wilson Creek Rd
Lawrenceburg, IN 47025
Phone (812) 496-8779
1640 Flossie Dr
Lawrenceburg, IN 47025
Phone (812) 496-3285
3700 Alexandria Pike
Cold Spring, KY 41076
Phone (859) 441-1336
334 Thomas More Pkwy
Ste 200
Crestview Hills, KY 41017
Phone (859) 344-3737
405 Violet Rd
Crittenden, KY 41030
Phone (859) 428-1610
1360 Dolwick Dr
Erlanger, KY 41018
Phone (800) 737-7900
85 N Grand Ave
Fort Thomas, KY 41075
Phone (859) 572-3100
1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700
2626 Alexandria Pike
Highland Heights, KY 41076
Phone (859) 757-0434
1400 Grand Ave
Newport, KY 41071
Phone (859) 905-3070
300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217
Interoperability endpoints
- sfernbach27485@direct-prd.stelizabeth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10002914A | IN | |
| Medical Physician Assistant | 363AM0700X | PA646 | KY | |
| Physician Assistant | 363A00000X | PA646 | KY | Yes |
Addresses
Primary practice location
405 Violet Rd
Crittenden, KY 41030-8956
Mailing address
PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 903-0268
Other practice location 1
1640 Flossie Dr
Greendale, IN 47025-8424
Phone (812) 496-3285
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 95002804 | Medicaid | KY |
Other names
- Suzanne M Bird
Other providers in Crittenden, KY
- Terry William Case
- Alisa-Ann Christensen
- Cincinnati Healthcare Group PSC, Dba Patient First Physicians Group
- Sandra Lynn Colston
- Christopher Duckworth
- Richard Flesch
- Foot Specialists of Greater Cincinnati
- Grant County Drugs-North
- Grant Pharmacist Group Inc
- Grant Pharmacist Group Inc
All providers in Crittenden, KY · Physician Assistant in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.