Individual provider Active NPI

Susan Kathleen Thompson, M.S.N. CPNP

  • Pediatric Nurse Practitioner
  • Columbus, OH
National Provider Identifier
1417221235
Registry record updated Jun 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN.142283-COA Issued in OH
Practice address
700 Childrens Dr
Columbus, OH 43205-2664
Phone
(614) 722-3275
Fax
(614) 355-3285
NPI assigned
Feb 24, 2012
Last updated
Jun 10, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN.142283-COA OH Primary

Addresses

Primary practice location

700 Childrens Dr
Columbus, OH 43205-2664

Mailing address

Dept 781625
P.O. Box 78000
Detroit, MI 48278-1625
Phone (614) 355-8004

Other identifiers 2

IdentifierTypeStateIssuer
2771666MedicaidOH
2846675MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160914002070 OH Practitioner - Nurse Practitioner 0648566810 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
RN.142283-COAOHMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Academic Association, Inc. Pediatrics CurrentSince Jul 5, 2016 Accepting new patients

Locations

700 Childrens Dr
Columbus, OH 43205
Phone (614) 722-4411

Dept L289
Columbus, OH 43260

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1330041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465516800000",
    "number": "1417221235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 781625",
            "address_2": "P.O. BOX 78000",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781625",
            "telephone_number": "614-355-8004",
            "fax_number": "614-355-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 CHILDRENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432052664",
            "telephone_number": "614-722-3275",
            "fax_number": "614-355-3285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "SUSAN",
        "middle_name": "KATHLEEN",
        "credential": "M.S.N. CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-24",
        "last_updated": "2016-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OH",
            "license": "RN.142283-COA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2771666",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2846675",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.