Individual provider Active NPI

Susan Elaine McClory, M.D, PH.D.

  • Pediatric Hematology & Oncology Physician
  • Philadelphia, PA
National Provider Identifier
1477964864
Registry record updated Jul 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
MT205893 Issued in PA
Practice address
3401 Civic Center Blvd
Philadelphia, PA 19104
Phone
(215) 590-1220
NPI assigned
May 19, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology Physician 2080P0207X MT205893 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Philadelphia, PA 19104

Mailing address

3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone (267) 425-3035

Other names 1

  • Susan Elaine Schmidt Former name

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171208001847 PA Practitioner - Pediatric Medicine 2860759347 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Ohio State University College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3401 Civic Ctr Blvd
Philadelphia, PA 19104-4319
Phone (215) 590-1000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT205893PAMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childen's Health Care Associates Inc. CurrentSince Oct 16, 2017 Accepting new patients
Childrens Health Care Associates, Inc Current Accepting new patients
Childrens Health Care Associates, Inc CurrentSince Oct 16, 2017 Accepting new patients
Childrens Health Care Associates of New Jersey PC Past Accepting new patients
Childrens Hospital of Philadelphia Past Accepting new patients

Locations

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

Organizations & group practices 5

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": "1400457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530835200000",
    "number": "1477964864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "267-425-3035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-590-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLORY",
        "first_name": "SUSAN",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "M.D, PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-19",
        "last_updated": "2018-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "PA",
            "license": "MT205893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "SCHMIDT",
            "middle_name": "ELAINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.