Active NPI
Suzanne T Mallatt, NP
- Nurse Practitioner
- Miami, OK
National Provider Identifier
1417984352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 147011
- Practice address
- 7600 S Highway 69a
Miami, OK 74354-1016 - Phone
- (918) 542-1655
- Fax
- (918) 540-1685
- NPI assigned
- Jun 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 147011 | MO | Primary |
Addresses
Primary practice location
7600 S Highway 69a
Miami, OK 74354-1016
Mailing address
9473 SE 80TH Ter
Baxter Springs, KS 66713-3278
Phone (620) 848-9826
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 425773108 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
7600 S Hwy 69a
Miami, OK 74354-1016
Phone (918) 542-1655
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeastern Tribal Health System | Current | Accepting new patients |
Locations
7600 S Highway 69A
Miami, OK 74354
Phone (918) 542-1655
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355875200000",
"number": "1417984352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9473 SE 80TH TER",
"city": "BAXTER SPRINGS",
"state": "KS",
"postal_code": "667133278",
"telephone_number": "620-848-9826",
"fax_number": "918-540-1685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7600 S HIGHWAY 69A",
"city": "MIAMI",
"state": "OK",
"postal_code": "743541016",
"telephone_number": "918-542-1655",
"fax_number": "918-540-1685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLATT",
"first_name": "SUZANNE",
"middle_name": "T",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-27",
"last_updated": "2012-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MO",
"license": "147011",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "425773108",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miami, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.