Individual provider Active NPI

Feiyan Su, N.P.

  • Women's Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1467909499
Registry record updated Sep 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
421262 Issued in NY
Practice address
568 Broadway
Suite 304
New York, NY 10012-3225
Phone
(212) 966-7600
NPI assigned
Sep 7, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 7, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 421262 NY Primary

Addresses

Primary practice location

568 Broadway
Suite 304
New York, NY 10012-3225

Mailing address

1070 Kennedy Blvd Apt 5D
Bayonne, NJ 07002-2040
Phone (551) 208-6967

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20250506001109 NY Practitioner - Nurse Practitioner 7517484330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Square Care Medical Group LLPGroup PAC ID 7012938434, 70 clinicians

Practice addresses (Care Compare)

285 Sills Rd
Suite D
East Patchogue, NY 11772-4869
Phone (631) 447-1032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
421262NYMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Square Care Medical Group, LLP CurrentSince Jun 1, 2025 Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients

Locations

285 Sills Rd
Ste D
East Patchogue, NY 11772
Phone (631) 438-0777

191 Herricks Rd
New Hyde Park, NY 11040
Phone (516) 248-0144

568 Broadway
Rm 304
New York, NY 10012
Phone (212) 966-7600

568 Broadway
Rm 404
New York, NY 10012
Phone (212) 966-7600

Interoperability endpoints

  • Direct secure messaging: feiyan.su.1@15987.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/15987/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473206400000",
    "number": "1467909499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 KENNEDY BLVD APT 5D",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070022040",
            "telephone_number": "551-208-6967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "568 BROADWAY",
            "address_2": "SUITE 304",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100123225",
            "telephone_number": "212-966-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "FEIYAN",
        "credential": "N.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2016-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NY",
            "license": "421262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.