Active NPI
Suzanne Lynn Bertram, MD
- Otolaryngology Physician
- Fort Collins, CO
National Provider Identifier
1427347889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 30896
- Practice address
- 2001 S Shields St #E101
Fort Collins, CO 80526-1872 - Phone
- (970) 493-5334
- Fax
- (970) 494-2008
- NPI assigned
- Apr 6, 2011
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 30896 | CO | Primary |
Addresses
Primary practice location
2001 S Shields St #E101
Fort Collins, CO 80526-1872
Mailing address
2001 S Shields St #E101
Fort Collins, CO 80526-1872
Phone (970) 493-5334
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30896 | CO | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311552000000",
"number": "1427347889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 S SHIELDS ST #E101",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805261872",
"telephone_number": "970-493-5334",
"fax_number": "970-494-2008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 S SHIELDS ST #E101",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805261872",
"telephone_number": "970-493-5334",
"fax_number": "970-494-2008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTRAM",
"first_name": "SUZANNE",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-06",
"last_updated": "2011-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "CO",
"license": "30896",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Collins, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.