Individual provider Active NPI

Susan Owens Rojas, NP

  • Acute Care Nurse Practitioner
  • Diberville, MS
National Provider Identifier
1417673484
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
905578 Issued in MS
Practice address
3661 Sangani Blvd Suite E
Diberville, MS 39540
Phone
(228) 354-0022
Fax
(228) 354-0088
NPI assigned
Oct 12, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 905578 MS
Acute Care Nurse Practitioner 363LA2100X 905578 MS Primary

Addresses

Primary practice location

3661 Sangani Blvd Suite E
Diberville, MS 39540

Mailing address

3661 Sangani Blvd Suite E
Diberville, MS 39540
Phone (228) 354-0022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20230209000119 MS Practitioner - Nurse Practitioner 5294107744 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Pace Mississippi PLLCGroup PAC ID 3678832029, 192 clinicians

Practice addresses (Care Compare)

3265 Hwy 90
Gautier, MS 39553-5121
Phone (931) 253-1110

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
905578MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Gulfport CurrentSince Nov 1, 2022 Accepting new patients
Upperline Healthcare, PC CurrentSince Sep 22, 2025 Accepting new patients
Upperline Healthcare, PC CurrentSince Sep 22, 2025 Accepting new patients
Fast Pace Mississippi, PLLC Family CurrentSince Mar 1, 2025 Accepting new patients
Community Care Health Network LLC CurrentSince Apr 1, 2024 Accepting new patients
South Mississippi Urgent Care CurrentSince Aug 27, 2023 Accepting new patients
Fast Pace Mississippi, PLLC CurrentSince Mar 1, 2025 Accepting new patients

Locations

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

2798 Pass Rd
Biloxi, MS 39531
Phone (228) 200-0340

3661 Sangani Blvd
Ste E
Diberville, MS 39540
Phone (228) 354-0022

3265 Highway 90
Gautier, MS 39553
Phone (228) 366-9136

2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

15200 Community Rd
Gulfport, MS 39503
Phone (228) 575-7000

7 Professional Pkwy
Ste 101
Hattiesburg, MS 39402
Phone (601) 781-1661

232 Market St
Jackson, MS 39232
Phone (588) 498-6767

517 City Ave S
Ripley, MS 38663
Phone (662) 587-8206

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1417673484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3661 SANGANI BLVD SUITE E",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "39540",
            "telephone_number": "228-354-0022",
            "fax_number": "228-354-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3661 SANGANI BLVD SUITE E",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "39540",
            "telephone_number": "228-354-0022",
            "fax_number": "228-354-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROJAS",
        "first_name": "SUSAN",
        "middle_name": "OWENS",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-12",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "905578",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "905578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Diberville, MS

Sources for this page

Verify at the official NPI Registry.