Susan Lacey Antonelli, NP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN.CNP.023456 Issued in OH

Practice address

17876 Saint Clair Ave
Cleveland, OH 44110-2602

Phone

(216) 383-2222

Fax

(216) 298-0241

NPI assigned

Aug 15, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Hospice of the Western Reserve at University Hospitals, LLC

  • Community Based Hospice Care Agency
  • Cleveland, OH
  • NPI 1821561614
  Medicare reassignment NPD
• Hospice of the Western Reserve, Inc.

  • Clinical Nurse Specialist
  • Cleveland, OH
  • NPI 1811163009
  Medicare reassignment

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

{
    "created_epoch": "1534291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1477033918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17876 SAINT CLAIR AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441102602",
            "telephone_number": "216-383-2222",
            "fax_number": "216-298-0241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17876 SAINT CLAIR AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441102602",
            "telephone_number": "216-383-2222",
            "fax_number": "216-298-0241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONELLI",
        "first_name": "SUSAN",
        "middle_name": "LACEY",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-15",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP.023456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Esther Anton
• George E Anton, M.D.
• Rachel Anton, FNP-BC
• Antone Feo and Associates
• Maria Josephine Antonelli, M.D.
• Nicolas Antonellis
• Maria Antonetti
• Elias Antoniou, M.D.
• Maria Blessy Antony
• Prestina Rose Antony

• Gerontology Nurse Practitioner in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Gerontology Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.