Susan Fackelman

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

6675 Issued in NY

Practice address

259 1St St
Mineola, NY 11501-3957

Phone

(516) 663-0333

NPI assigned

Sep 25, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore - Lij Anesthesiology, PCGroup PAC ID 1153602453, 990 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Long Island Jewish Medical Center Hospital, New Hyde Park, NY, CCN 330195

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989

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.

• North Shore - Lij Anesthesiology, PC

  • Anesthesiology Physician
  • Chappaqua, NY
  • NPI 1417401266

  Single Specialty

  Medicare reassignment Care Compare group NPD
• North American Partners in Anesthesia LLP

  • Anesthesiology Physician
  • Melville, NY
  • NPI 1649264706

  Single Specialty

  NPD
• Nassau Anesthesia Associates PC

  • Anesthesiology Physician
  • Mineola, NY
  • NPI 1578961645

  Single Specialty

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Long Island Jewish Medical Center

  • General Acute Care Hospital
  • New Hyde Park, NY
  • NPI 1285641514
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594684800000",
    "number": "1437259777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 1ST ST",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013901",
            "telephone_number": "516-741-0570",
            "fax_number": "516-741-8276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 1ST ST",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013957",
            "telephone_number": "516-663-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACKELMAN",
        "first_name": "SUSAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "407482",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "6675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Certified Registered Nurse Anesthetist in Mineola, NY
• Providers in Mineola, NY by specialty
• Certified Registered Nurse Anesthetist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.