Susan C Fair DO PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS7489 Issued in FL

Legal business name

SUSAN C FAIR DO PA

Practice address

595 N Courtenay Pkwy
Suite 102
Merritt Island, FL 32953-4851

Phone

(321) 455-1226

Fax

(321) 456-5531

NPI assigned

Jul 16, 2007

Organization subpart

No

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

Authorized official

Name

Susan C Fair, DONPI 1457351223

Title

President

Phone

(321) 455-1226

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Carole Fair, DO

  • Family Medicine Physician
  • Merritt Island, FL
  • NPI 1457351223
  Medicare reassignment NPD Authorized official
• Dawn Jennifer Banke, ARNP

  • Family Nurse Practitioner
  • Titusville, FL
  • NPI 1780889899
  NPD (past)

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189728000000",
    "number": "1407055874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 N COURTENAY PKWY",
            "address_2": "SUITE 102",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534851",
            "telephone_number": "321-455-1226",
            "fax_number": "321-456-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 N COURTENAY PKWY",
            "address_2": "SUITE 102",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329534851",
            "telephone_number": "321-455-1226",
            "fax_number": "321-456-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN C FAIR DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2007-09-14",
        "status": "A",
        "authorized_official_last_name": "FAIR",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-455-1226",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS7489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "OS7489",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brett Stroze, D.C.
• David John Strunk, O.D.
• Jill Stutts, PT, ATC
• Sundance Ranch Christian Church
• Surgical Physician Assistants LLC
• Susan D. Berry, Ma, LMHC, P.a.
• Meghan Susko
• Paulette Swanson, PT
• Catherine Bess Sweeney, LPN
• Gretchen Lee Adams Syfert, AU.D.

• Family Medicine Physician in Merritt Island, FL
• Providers in Merritt Island, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.