Susan Petokas, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

SP001243B Issued in PA

Practice address

820 S Washington Ave
Scranton, PA 18505-1639

Phone

(570) 595-4496

Fax

(570) 961-3844

NPI assigned

Aug 12, 2010

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

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1982

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: susan.petokas.1@27525.direct.athenahealth.com

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.

• Maternal & Family Health Services Inc

  • Clinic/Center
  • Scranton, PA
  • NPI 1740669530
  NPD (past)
• Maternal & Family Health Services Inc

  • Clinic/Center
  • Hazleton, PA
  • NPI 1811210636

  Multi-Specialty

  NPD (past)
• Maternal & Family Health Services, Inc.

  • Clinic/Center
  • Pottsville, PA
  • NPI 1053538470

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1467767590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PUBLIC SQ STE 600",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187011704",
            "telephone_number": "570-826-1777",
            "fax_number": "570-823-3450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 S WASHINGTON AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185051639",
            "telephone_number": "570-595-4496",
            "fax_number": "570-961-3844"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 W Chestnut St Ste 9",
            "address_purpose": "LOCATION",
            "city": "Hazleton",
            "state": "PA",
            "postal_code": "182016419",
            "country_code": "US",
            "telephone_number": "570-826-1777",
            "fax_number": "570-823-3450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETOKAS",
        "first_name": "SUSAN",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-12",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP001243B",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP001243B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007678420050",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026041580002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007678420035",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102604158004",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102604158005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Aneila Persaud Shewnarain, DO
• Personal Promise Homecare, LLC.
• John William Peters, MD
• Laura Peters, PA-C
• Dominick A. Petitto, MS, NCC, LPC
• Jessica Petrilak
• Mark Petrole, RN
• Scott J. Pettinato, D.M.D.
• Dana Pezzuti, MSOTR/L
• David Ka Pun Phang, MD

• Nurse Practitioner in Scranton, PA
• Providers in Scranton, PA by specialty
• Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.