Individual provider Active NPI

Susie C Drake, M.D.

  • Ophthalmology Physician
  • Madison, WI
National Provider Identifier
1487092078
Registry record updated Jun 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
66916 Issued in WI
Practice address
2880 University Ave
Madison, WI 53705-3644
Phone
(608) 263-7171
Fax
(608) 265-8060
NPI assigned
Jun 5, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Ophthalmology Physician 207W00000X 66916 WI Primary

Addresses

Primary practice location

2880 University Ave
Madison, WI 53705-3644

Mailing address

123 Hospital Dr
Ste 1002
Watertown, WI 53098-3320
Phone (920) 261-8225

Other names 1

  • Susie Chen Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20170524001455 WI Practitioner - Ophthalmology 4981914140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Wisconsin School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Watertown Physician Practices LLCGroup PAC ID 8022329408, 64 clinicians

Practice addresses (Care Compare)

123 Hospital Dr
Watertown, WI 53098-3320

125 Hospital Dr
Watertown, WI 53098-3303
Phone (920) 262-4449

1507 Doctors CT
Watertown, WI 53094-4101
Phone (920) 261-4111

Hospital & facility affiliations

  • Watertown Memorial Hospital Hospital, Watertown, WI, CCN 520116
  • Fort Memorial Hospital Hospital, Fort Atkinson, WI, CCN 520071
  • Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery233

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Watertown Physician Practices LLC Current Accepting new patients
Watertown Physician Practices LLC Ophthalmology CurrentSince Sep 11, 2018 Accepting new patients

Locations

540 Village Walk Ln
Ste J
Johnson Creek, WI 53038
Phone (920) 699-4388

123 Hospital Dr
Watertown, WI 53098
Phone (920) 262-4412

123 Hospital Dr
Ste 1002
Watertown, WI 53098
Phone (920) 261-8225

1507 Doctors Ct
Watertown, WI 53094
Phone (920) 261-4111

Interoperability endpoints

  • Direct secure messaging: susie.drake.1@17022.direct.athenahealth.com

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.

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": "1370390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527811200000",
    "number": "1487092078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 HOSPITAL DR",
            "address_2": "STE 1002",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983320",
            "telephone_number": "920-261-8225",
            "fax_number": "920-261-5343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2880 UNIVERSITY AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537053644",
            "telephone_number": "608-263-7171",
            "fax_number": "608-265-8060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAKE",
        "first_name": "SUSIE",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-05",
        "last_updated": "2018-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WI",
            "license": "66916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSIE",
            "last_name": "CHEN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.