Active NPI
Susan M. Fazekas, FPN
- Nurse Practitioner
- Chesterton, IN
National Provider Identifier
1467448654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71000803A
- Practice address
- 259 Paul Revere Dr
Chesterton, IN 46304-9371 - Phone
- (219) 405-6779
- NPI assigned
- Sep 22, 2005
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71000803A | IN | Primary |
Addresses
Primary practice location
259 Paul Revere Dr
Chesterton, IN 46304-9371
Mailing address
259 Paul Revere Dr
Chesterton, IN 46304-9371
Phone (219) 405-6779
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | s.fazekas@lbji.exscribedirect.com |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71000803A | IN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618185600000",
"number": "1467448654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "259 PAUL REVERE DR",
"city": "CHESTERTON",
"state": "IN",
"postal_code": "463049371",
"telephone_number": "219-405-6779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "259 PAUL REVERE DR",
"city": "CHESTERTON",
"state": "IN",
"postal_code": "463049371",
"telephone_number": "219-405-6779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAZEKAS",
"first_name": "SUSAN",
"middle_name": "M.",
"name_prefix": "Mrs.",
"credential": "FPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-22",
"last_updated": "2021-04-12",
"certification_date": "2021-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "71000803A",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "s.fazekas@lbji.exscribedirect.com",
"affiliation": "N",
"address_1": "601 Gateway Blvd N",
"city": "Chesterton",
"state": "IN",
"country_code": "US",
"postal_code": "463049658",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Chesterton, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.