Active NPI
Susanna Sackitey
- Family Medicine Physician
- Pasadena, CA
National Provider Identifier
1427534767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A173389
- Practice address
- 3160 E del Mar Blvd
Pasadena, CA 91107-4649 - Phone
- (626) 398-6300
- NPI assigned
- Jul 18, 2018
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A173389 | CA | Primary |
Addresses
Primary practice location
3160 E del Mar Blvd
Pasadena, CA 91107-4649
Mailing address
455 W Montana St
Pasadena, CA 91103-1327
Phone (626) 993-1212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250910004627 | CA | Order and Referring Only - Family Practice | 3870983240 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A173389 | CA | MD | Family Medicine Physician |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630886400000",
"number": "1427534767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "455 W MONTANA ST",
"city": "PASADENA",
"state": "CA",
"postal_code": "911031327",
"telephone_number": "626-993-1212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3160 E DEL MAR BLVD",
"city": "PASADENA",
"state": "CA",
"postal_code": "911074649",
"telephone_number": "626-398-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SACKITEY",
"first_name": "SUSANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-18",
"last_updated": "2021-09-06",
"certification_date": "2021-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A173389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2021; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.