NPIMap

Individual provider Active NPI

Susan Jennifer Carbognin, M.D.

  • Diagnostic Radiology Physician
  • Andrews AFB, MD
National Provider Identifier
1407956956
Registry record updated Aug 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
AFE111304 Issued in CA
Practice address
1060 W Perimeter Rd
Andrews AFB, MD 20762-6601
Phone
(240) 612-2020
NPI assigned
Sep 25, 2006
Last updated
Aug 22, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X AFE111304 CA Primary

Addresses

Primary practice location

1060 W Perimeter Rd
Andrews AFB, MD 20762-6601

Mailing address

1060 W Perimeter Rd
Andrews AFB, MD 20762-6601
Phone (240) 612-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20251001004460 WI Practitioner - Diagnostic Radiology 1456857184 Reassigns benefits to 1 organization
I20260611003512 DC Practitioner - Diagnostic Radiology 1456857184 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Radiology Wisconsin LLCGroup PAC ID 9537595533, 111 clinicians

Practice addresses (Care Compare)

10180 Washington Ave
Mount Pleasant, WI 53177-1604
Phone (414) 973-7830

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
AFE111304CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Radiology Wisconsin, LLC Diagnostic Radiology CurrentSince Sep 22, 2025 Accepting new patients
Wisconsin Radiology Specialists, S C Past Accepting new patients

Locations

10180 Washington Ave
Mount Pleasant, WI 53177
Phone (414) 769-4040

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471824000000",
    "number": "1407956956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 W PERIMETER RD",
            "city": "ANDREWS AFB",
            "state": "MD",
            "postal_code": "207626601",
            "telephone_number": "240-612-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 W PERIMETER RD",
            "city": "ANDREWS AFB",
            "state": "MD",
            "postal_code": "207626601",
            "telephone_number": "240-612-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARBOGNIN",
        "first_name": "SUSAN",
        "middle_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2016-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "AFE111304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Andrews AFB, MD

Sources for this page

Verify at the official NPI Registry.