Active NPI
Susanne Gill, PHD
- Psychologist
- Verona, WI
National Provider Identifier
1417914300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2388-057
- Practice address
- 1122 Feather Edge Dr
Verona, WI 53593-7841 - Phone
- (608) 250-2492
- NPI assigned
- Apr 26, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2388 | WI | |
| Psychologist | 103T00000X | 2388-057 | WI | Primary |
Addresses
Primary practice location
1122 Feather Edge Dr
Verona, WI 53593-7841
Mailing address
PO Box 46263
Madison, WI 53744-6263
Phone (608) 250-2492
Other practice location 1
14 W Mifflin St
Suite 210
Madison, WI 53703-2576
Phone (608) 250-2492
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 1, 2023 through Sep 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2388 | WI | MD | Psychologist |
| 2388-057 | WI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609718400000",
"number": "1417914300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 46263",
"city": "MADISON",
"state": "WI",
"postal_code": "537446263",
"telephone_number": "608-250-2492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1122 FEATHER EDGE DR",
"city": "VERONA",
"state": "WI",
"postal_code": "535937841",
"telephone_number": "608-250-2492"
}
],
"practiceLocations": [
{
"address_1": "14 W Mifflin St",
"address_2": "Suite 210",
"address_purpose": "LOCATION",
"city": "Madison",
"state": "WI",
"postal_code": "537032576",
"country_code": "US",
"telephone_number": "608-250-2492",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GILL",
"first_name": "SUSANNE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-26",
"last_updated": "2021-01-04",
"certification_date": "2021-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "2388",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "2388-057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Verona, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.