Active NPI
Rangsan Suvan, MD
- Pediatrics Physician
- Poplar Bluff, MO
National Provider Identifier
1467424416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- R5641
- Practice address
- 2500 Lucy Lee Parkway
Poplar Bluff, MO 63901 - Phone
- (573) 686-2585
- Fax
- (573) 686-4415
- NPI assigned
- Feb 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | R5641 | MO | Primary |
Addresses
Primary practice location
2500 Lucy Lee Parkway
Poplar Bluff, MO 63901
Mailing address
2500 Lucy Lee Parkway
Poplar Bluff, MO 63901
Phone (573) 686-2585
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200331510 | Medicaid | MO | |
| 108033001 | Other | AR | ARKANSAS INDIVIDUAL MEDICAID NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R5641 | MO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Clinic | Pediatrics | Past | Accepting new patients |
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.
-
- Pediatrics Physician
- Poplar Bluff, MO
- NPI 1609037381
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214179200000",
"number": "1467424416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 LUCY LEE PARKWAY",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "63901",
"telephone_number": "573-686-2585",
"fax_number": "573-686-4415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 LUCY LEE PARKWAY",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "63901",
"telephone_number": "573-686-2585",
"fax_number": "573-686-4415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUVAN",
"first_name": "RANGSAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-03",
"last_updated": "2008-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MO",
"license": "R5641",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200331510",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARKANSAS INDIVIDUAL MEDICAID NUMBER",
"identifier": "108033001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.