Active NPI
Susan M. Mix, FNP
- Family Nurse Practitioner
- Medford, OR
National Provider Identifier
1467647115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 200750116NP
- Practice address
- 760 Golf View Drive
Suite #200
Medford, OR 97504 - Phone
- (541) 618-4400
- Fax
- (541) 618-4406
- NPI assigned
- Sep 6, 2007
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 200750116NP | OR | Primary |
Addresses
Primary practice location
760 Golf View Drive
Suite #200
Medford, OR 97504
Mailing address
760 Golf View Drive
Suite #200
Medford, OR 97504
Phone (541) 618-4400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 227698 | Medicaid | OR |
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 |
|---|---|---|---|
| 200750116NP | OR | MD | Family Nurse Practitioner |
Interoperability endpoints
- susanmix@rccpc.allscriptsdirect.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380153600000",
"number": "1467647115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "760 GOLF VIEW DRIVE",
"address_2": "SUITE #200",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97504",
"telephone_number": "541-618-4400",
"fax_number": "541-618-4406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 GOLF VIEW DRIVE",
"address_2": "SUITE #200",
"city": "MEDFORD",
"state": "OR",
"postal_code": "97504",
"telephone_number": "541-618-4400",
"fax_number": "541-618-4406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIX",
"first_name": "SUSAN",
"middle_name": "M.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-06",
"last_updated": "2013-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OR",
"license": "200750116NP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "227698",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.