Individual provider Active NPI

Susan Clemons-Peragine, MS, CCC-SLP

  • Speech-Language Pathologist
  • North Las Vegas, NV
National Provider Identifier
1437571239
Registry record updated Oct 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP-1556 Issued in NV
Practice address
5021 Camino Libre St
North Las Vegas, NV 89031-2400
Phone
(828) 335-9088
NPI assigned
Jan 13, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP-1556 NV Primary

Addresses

Primary practice location

5021 Camino Libre St
North Las Vegas, NV 89031-2400

Mailing address

5021 Camino Libre St
North Las Vegas, NV 89031-2400
Phone (828) 335-9088

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241014002182 TN Practitioner - Qualified Speech Language Pathologist 2769914910 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
4722TNMDGeneral Practice Dentistry
SP-1556NVMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Grace Rehabilitation Center, Inc. CurrentSince Jul 28, 2024 Accepting new patients

Locations

2435 Jacksboro Pike
Ste 3
La Follette, TN 37766
Phone (423) 449-8135

2435 Jacksboro Pike
Ste 2
La Follette, TN 37766
Phone (423) 566-2250

2435 Jacksboro Pike
La Follette, TN 37766
Phone (423) 566-2250

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": "1389571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412640000000",
    "number": "1437571239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5021 CAMINO LIBRE ST",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890312400",
            "telephone_number": "828-335-9088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5021 CAMINO LIBRE ST",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890312400",
            "telephone_number": "828-335-9088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMONS-PERAGINE",
        "first_name": "SUSAN",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-13",
        "last_updated": "2014-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NV",
            "license": "SP-1556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.