Susan Deen, NP

Key facts

NPI

1497536866

Entity type

Individual (NPI type 1)

Primary specialty

Gerontology Nurse Practitioner 363LG0600X

License

RN180793 (GA)

Practice address

3345 US Highway 84 Ste 102
Blackshear, GA 31516-2160

Phone

(912) 208-3581

NPI assigned

Oct 11, 2023

Sex

Female

Sole proprietor

Yes

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.

• RMX Blackshear LLC Endocrinology, Diabetes & Metabolism Physician · Blackshear, GA · NPI 1174287379
  Medicare reassignment NPD GA
• Tennessee Vascular and Thoracic Surgical Associates, PC Specialist · Tullahoma, TN · NPI 1093263055
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 11, 2023.

{
    "created_epoch": "1696982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1497536866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1318",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315021318",
            "telephone_number": "912-288-7617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 US HIGHWAY 84 STE 102",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "315162160",
            "telephone_number": "912-208-3581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEEN",
        "first_name": "SUSAN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-11",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "GA",
            "license": "RN180793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Blackshear, GA · Gerontology Nurse Practitioner in Georgia