Individual provider Active NPI

Susannah Ehret, MD

  • Internal Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1447251640
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A68091 Issued in CA
Practice address
8540 S Sepulveda Blvd
Suite 818
Los Angeles, CA 90045-3807
Phone
(310) 670-3255
Fax
(310) 531-2325
NPI assigned
Aug 10, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A68091 CA
Internal Medicine Physician 207R00000X A68091 CA Primary

Addresses

Primary practice location

8540 S Sepulveda Blvd
Suite 818
Los Angeles, CA 90045-3807

Mailing address

11539 Hawthorne Blvd
6TH Floor
Hawthorne, CA 90250-2381
Phone (310) 675-5370

Other identifiers 1

IdentifierTypeStateIssuer
00A68091AMedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100329000774 CA Practitioner - Internal MedicinePractitioner - Pediatric Medicine 3870629827 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Yale University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

20000 Rinaldi St
Porter Ranch, CA 91326-4900
Phone (877) 608-0044

5601 De Soto Ave
Woodland Hills, CA 91367-6701
Phone (818) 719-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Sep 6, 2016 Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 6, 2016 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Axminster Medical Group Internal Medicine Past Accepting new patients
Providence Medical Institute Internal Medicine Past Accepting new patients

Locations

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

Organizations & group practices 5

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1447251640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11539 HAWTHORNE BLVD",
            "address_2": "6TH FLOOR",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502381",
            "telephone_number": "310-675-5370",
            "fax_number": "310-531-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8540 S SEPULVEDA BLVD",
            "address_2": "SUITE 818",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900453807",
            "telephone_number": "310-670-3255",
            "fax_number": "310-531-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHRET",
        "first_name": "SUSANNAH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-10",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A68091",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A68091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A68091A",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.