Susan Marie Yatzun, DPM
Individual provider Active NPI Podiatrist · Cedar Grove, TN
NPI 1366540338 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1366540338
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- DPM000364 (TN)
- Practice address
- 660 Moss Creek Rd
Cedar Grove, TN 38321-7260 - Phone
- (731) 987-2299
- NPI assigned
- Sep 21, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111214000921 | TN | Practitioner - Podiatry | 4486829736 | Practice locations: McKenzie, TN; Milan, TN; Memphis, TN; Dresden, TN; Centerville, TN; Cedar Grove, TN; Bruceton, TN; Bartlett, TN |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | DPM000364 | TN | Yes |
Addresses
Primary practice location
660 Moss Creek Rd
Cedar Grove, TN 38321-7260
Mailing address
660 Moss Creek Rd
Cedar Grove, TN 38321-7260
Phone (731) 987-2299
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3351710 | Medicaid | TN | |
| 0177643 | Other | TN | BCBS OF TN |
Other providers in Cedar Grove, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.