Active NPI
Susan V. Breazeale, APRN
- Neurology Physician
- Clemson, SC
National Provider Identifier
1366642019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 1711
- Practice address
- 220 Keowee TRL
Clemson, SC 29631-1448 - Phone
- (864) 653-4071
- Fax
- (864) 653-4074
- NPI assigned
- Jul 20, 2007
- Last updated
- Feb 10, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 1711 | SC | Primary |
Addresses
Primary practice location
220 Keowee TRL
Clemson, SC 29631-1448
Mailing address
PO Box 2089
Easley, SC 29641-2089
Phone (864) 855-5104
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP3805 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1711 | SC | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baptist Easley | Past | Accepting new patients |
Interoperability endpoints
- susan.breazeale.p1@direct.actslife.nextgenshare.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
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- Internal Medicine Physician
- Rock Hill, SC
- NPI 1700353448
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265760000000",
"number": "1366642019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2089",
"city": "EASLEY",
"state": "SC",
"postal_code": "296412089",
"telephone_number": "864-855-5104",
"fax_number": "864-859-9362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 KEOWEE TRL",
"city": "CLEMSON",
"state": "SC",
"postal_code": "296311448",
"telephone_number": "864-653-4071",
"fax_number": "864-653-4074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREAZEALE",
"first_name": "SUSAN",
"middle_name": "V.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-20",
"last_updated": "2010-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "SC",
"license": "1711",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP3805",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clemson, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2010; 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.