Susan Margaret Kallal, MD PHARM D

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

60450667 Issued in WA

Practice address

4540 Cordata Pkwy
Suite 101
Bellingham, WA 98226-8059

Phone

(360) 255-5049

Fax

(360) 778-2395

NPI assigned

Dec 15, 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 AZ

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

Specialty

Dermatology

Education

University of Texas Medical School at San Antonio, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

30 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

100

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Pharmacy

State licenses

Practice roles

Locations

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.

• Carefree Dermatology PC

  • Dermatology Physician
  • Cave Creek, AZ
  • NPI 1598493629
  Medicare reassignment NPD Authorized official
• Susan M Kallal, M.D. Pharm.D., a.M.C

  • Dermatology Physician
  • Los Angeles, CA
  • NPI 1174705560
  NPD (past) Authorized official
• Gabriele Aesthetics Inc

  • Dermatology Physician
  • Arcadia, CA
  • NPI 1154744373
  NPD (past)
• Motion Picture and Television Fund Medical Group Inc

  • Geriatric Medicine (Internal Medicine) Physician
  • Woodland Hills, CA
  • NPI 1528265584
  NPD (past)
• Motion Picture and Television Fund Medical Group, Inc

  • Internal Medicine Physician
  • Glendale, CA
  • NPI 1821324542
  NPD (past)
• Silver Falls Dermatology, LLC

  • Dermatology Physician
  • Salem, OR
  • NPI 1134375421
  NPD (past)

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425427200000",
    "number": "1447312384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4540 CORDATA PKWY",
            "address_2": "SUITE 101",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982268059",
            "telephone_number": "360-255-5049",
            "fax_number": "360-778-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 CORDATA PKWY",
            "address_2": "SUITE 101",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982268059",
            "telephone_number": "360-255-5049",
            "fax_number": "360-778-2395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLAL",
        "first_name": "SUSAN",
        "middle_name": "MARGARET",
        "name_prefix": "Ms.",
        "credential": "MD PHARM D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2015-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "60450667",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A70271",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lihau Kahoohanohano, LPN
• Kailo Bodywork Associates Inc
• Lynne Marie Kain, L.M.P.
• Kaiser Foundation Health Plan of Washington
• Frederick S. Kaiser, M.D.
• Sara Kallin, LMP
• Haley Kallmyer
• Noelle Kalom, LMP
• Elijah Kamermans, MD
• Viktoriya Kammerer, SLP

• Dermatology Physician in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Dermatology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; 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.
• 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.