Susan M Bublick, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10000822 Issued in IN

Practice address

870 Colfax Ave
Benton Harbor, MI 49022-7409

Phone

(269) 927-5400

Fax

(269) 927-5493

NPI assigned

Oct 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Lakeland Community Hospital Watervliet

  • Rural Health Clinic/Center
  • Watervliet, MI
  • NPI 1508924770
  NPD (past)
• Indiana Radiology Partners, Inc

  • Diagnostic Radiology Physician
  • Indianapolis, IN
  • NPI 1497712160
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345507200000",
    "number": "1497841589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 INDUSTRIAL PARK RD",
            "city": "BANGOR",
            "state": "MI",
            "postal_code": "490131246",
            "telephone_number": "269-427-7937",
            "fax_number": "269-427-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 COLFAX AVE",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490227409",
            "telephone_number": "269-927-5400",
            "fax_number": "269-927-5493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUBLICK",
        "first_name": "SUSAN",
        "middle_name": "M",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2012-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10000822",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601002144",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elaine Gordon Brown, BSW
• Julie Kay Brown, LMSW
• Shawna Brown
• Gwendolyn Broyles
• Emily Bublick
• Damonica Buford, CNA
• Javonna Bullocks
• Quionna M Bullocks
• Vonshika Renea Bullocks
• Jabryia K Burden

• Physician Assistant in Benton Harbor, MI
• Providers in Benton Harbor, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.