Individual provider Active NPI

Anna Tayeko Suskin

  • Physical Therapist
  • Los Angeles, CA
National Provider Identifier
1487212080
Registry record updated Aug 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT296986 Issued in CA
Practice address
1640 Marengo Street Hra 102
Los Angeles, CA 90089-3603
Phone
(323) 865-1200
NPI assigned
May 30, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT296986 CA Primary

Addresses

Primary practice location

1640 Marengo Street Hra 102
Los Angeles, CA 90089-3603

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 865-1200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190829002427 CA Practitioner - Physical Therapist in Private Practice 4789912692 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

1640 Marengo St
Los Angeles, CA 90033-1036
Phone (323) 223-4091

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT296986CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sportsfit Physical Therapy Corporation Physical Therapist CurrentSince Sep 28, 2020 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Aug 1, 2019 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Aug 1, 2019 Accepting new patients

Locations

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1640 Marengo St
Ste 102
Los Angeles, CA 90033
Phone (323) 224-7070

1640 Marengo St
Los Angeles, CA 90033
Phone (323) 223-4091

1031 W 34th St
Ste 450
Los Angeles, CA 90089
Phone (213) 740-0215

4702 Lincoln Blvd
Marina del Rey, CA 90292
Phone (310) 306-1478

2010 Wilshire Blvd
Santa Monica, CA 90403
Phone (310) 878-2540

Organizations & group practices 3

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": "1559174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1487212080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-865-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 MARENGO STREET HRA 102",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900893603",
            "telephone_number": "323-865-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSKIN",
        "first_name": "ANNA",
        "middle_name": "TAYEKO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-30",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT296986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.