Individual provider Active NPI

Susan Blosser

  • Family Nurse Practitioner
  • Elgin, IL
National Provider Identifier
1497201172
Registry record updated Aug 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.014702041.370959 Issued in IL
Practice address
1425 N Randall Rd
Elgin, IL 60123-2300
Phone
(847) 742-9800
NPI assigned
Aug 31, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.014702041.370959 IL Primary

Addresses

Primary practice location

1425 N Randall Rd
Elgin, IL 60123-2300

Mailing address

2216 Crystal Cir
Crystal Lake, IL 60012-2210

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20240808002324 IA Practitioner - Nurse Practitioner 2163701764 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

PO Box
Suite 22000
San Angelo, TX 76902

PO Box
Suite 22000
San Angelo, TX 76902-7200

Hospital & facility affiliations

  • Shannon Medical Center Hospital, San Angelo, TX, CCN 450571

Merit-based Incentive Payment System (MIPS)

Final score
82.63 of 100Reported as group
Quality
78.21
Promoting interoperability
96
Improvement activities
40
Cost
67.22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209.014702041.370959ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shannon Clinic CurrentSince Oct 16, 2024 Accepting new patients
Unitypoint Health - Marshalltown CurrentSince Sep 23, 2024 Accepting new patients
Unitypoint Health - Marshalltown CurrentSince Sep 23, 2024 Accepting new patients

Locations

55 Unitypoint Way
Marshalltown, IA 50158
Phone (641) 754-5145

120 E Beauregard Ave
San Angelo, TX 76903
Phone (915) 658-1511

120 E Harris Ave
San Angelo, TX 76903
Phone (325) 653-6741

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.

Hospital & facility affiliations 1

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": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472601600000",
    "number": "1497201172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2216 CRYSTAL CIR",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600122210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 N RANDALL RD",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601232300",
            "telephone_number": "847-742-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOSSER",
        "first_name": "SUSAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-31",
        "last_updated": "2016-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.014702041.370959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

Verify at the official NPI Registry.