Active NPI
Susan Renae Ingram, LPTA
- Physical Therapy Assistant
- Flora, IL
National Provider Identifier
1427693126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160-003878
- Practice address
- 911 Stacey Burk Dr
Flora, IL 62839-3241 - Phone
- (618) 292-4655
- NPI assigned
- Nov 17, 2019
- Last updated
- Nov 21, 2019
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160-003878 | IL | Primary |
Addresses
Primary practice location
911 Stacey Burk Dr
Flora, IL 62839-3241
Mailing address
392 Goshawk LN
Farina, IL 62838-3734
Phone (618) 292-4655
Other practice location 1
1704 Summers End Ln
Fenton, MO 63026-6967
Phone (618) 292-4655
Other practice location 2
W N 12th St
Shelbyville, IL 62565
Phone (618) 292-4655
Other practice location 3
208 Zachery Dr
Mount Vernon, IL 62864-6712
Phone (618) 292-4655
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160-003878 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1573948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574294400000",
"number": "1427693126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "392 GOSHAWK LN",
"city": "FARINA",
"state": "IL",
"postal_code": "628383734",
"telephone_number": "618-292-4655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "911 STACEY BURK DR",
"city": "FLORA",
"state": "IL",
"postal_code": "628393241",
"telephone_number": "618-292-4655"
}
],
"practiceLocations": [
{
"address_1": "1704 Summers End Ln",
"address_purpose": "LOCATION",
"city": "Fenton",
"state": "MO",
"postal_code": "630266967",
"country_code": "US",
"telephone_number": "618-292-4655",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "W N 12th St",
"address_purpose": "LOCATION",
"city": "Shelbyville",
"state": "IL",
"postal_code": "62565",
"country_code": "US",
"telephone_number": "618-292-4655",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "208 Zachery Dr",
"address_purpose": "LOCATION",
"city": "Mount Vernon",
"state": "IL",
"postal_code": "628646712",
"country_code": "US",
"telephone_number": "618-292-4655",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "INGRAM",
"first_name": "SUSAN",
"middle_name": "RENAE",
"name_prefix": "Mrs.",
"credential": "LPTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-17",
"last_updated": "2019-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160-003878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.