Heidi B Sutanto, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

40828 Issued in AZ

Practice address

9300 Dewitt Loop
Oaks Pavilion, 1St Floor
Fort Belvoir, VA 22060

Phone

(571) 231-3110

Fax

(571) 231-6697

NPI assigned

May 4, 2007

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548806400000",
    "number": "1457563199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9300 DEWITT LOOP",
            "city": "FORT BELVOIR",
            "state": "VA",
            "postal_code": "220605285",
            "telephone_number": "571-231-3110",
            "fax_number": "571-231-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 DEWITT LOOP",
            "address_2": "OAKS PAVILION, 1ST FLOOR",
            "city": "FORT BELVOIR",
            "state": "VA",
            "postal_code": "22060",
            "telephone_number": "571-231-3110",
            "fax_number": "571-231-6697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTANTO",
        "first_name": "HEIDI",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2019-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "40828",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "40828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryung Suh, MD
• Edward Sun
• Sundace Rehabilitation
• Sundance Rehabilition
• Lauren Suszan, CRNA
• Sean Edward Sykes, DO
• Michelle Szczepanik, MD
• Michael Paul Szczepanski, M.D.
• Libertine Magallon Tabo
• Mary N Tabot, PHARMD

• Internal Medicine Physician in Fort Belvoir, VA
• Providers in Fort Belvoir, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.