NPIMap

Individual provider Active NPI

Jesse John Susa, MD

  • Family Medicine Physician
  • Black River Falls, WI
National Provider Identifier
1477901395
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
69790-20 Issued in WI
Practice address
610 W Adams St
Black River Falls, WI 54615
Phone
(715) 284-1867
NPI assigned
Jun 1, 2016
Last updated
Jun 30, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 69790-20 WI Primary

Addresses

Primary practice location

610 W Adams St
Black River Falls, WI 54615

Mailing address

610 W Adams St
Black River Falls, WI 54615-9110
Phone (715) 284-1867

Other practice location 1

330 N 8th Ave E
Duluth, MN 55805-2024
Phone (218) 723-1112

Other practice location 2

711 W Adams St
Black River Falls, WI 54615-5052
Phone (715) 284-5361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190801002090 WI Practitioner - Family Practice 4082906649 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Black River Health IncGroup PAC ID 3173431178, 62 clinicians

Practice addresses (Care Compare)

711 W Adams St
Black River Falls, WI 54615-5052
Phone (715) 284-5361

711 W Adams St
Black River Falls, WI 54615-9108

724 Rose St
Black River Falls, WI 54615-9278

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.18 of 100Reported as group
Quality
87.29
Promoting interoperability
100
Improvement activities
40
Cost
65.34

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
69790-20WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Black River Health Inc CurrentSince Sep 5, 2019 Accepting new patients
Black River Health Inc CurrentSince Sep 5, 2019 Accepting new patients
Krohn Clinic LTD. Family Medicine CurrentSince Sep 1, 2019 Accepting new patients
Black River Health Inc Current Accepting new patients
The Duluth Clinic, LTD. Past Accepting new patients
Duluth Graduate Medical Education Council Inc Family Medicine PastSince Jun 22, 2004 Accepting new patients

Locations

610 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-4311

711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-1302

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BHJBDA
  • Direct secure messaging: jesse.susa@kcld.eclinicaldirectplus.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1477901395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159110",
            "telephone_number": "715-284-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "54615",
            "telephone_number": "715-284-1867"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 N 8th Ave E",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558052024",
            "country_code": "US",
            "telephone_number": "218-723-1112",
            "fax_number": "218-529-9120",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "711 W Adams St",
            "address_purpose": "LOCATION",
            "city": "Black River Falls",
            "state": "WI",
            "postal_code": "546155052",
            "country_code": "US",
            "telephone_number": "715-284-5361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUSA",
        "first_name": "JESSE",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-01",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "69790-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Black River Falls, WI

Sources for this page

Verify at the official NPI Registry.