Susan Jane Watson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

110025 Issued in MO

Practice address

114 E South Hills Dr
Maryville, MO 64468-2659

Phone

(660) 562-2525

Fax

(660) 562-4303

NPI assigned

Jan 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Northwest Medical Center Association Inc

  dba Mosaic Medical Center Albany

  • Medicare Defined Swing Bed Hospital Unit
  • Albany, MO
  • NPI 1124164322
  Medicare reassignment NPD
• Mosaic Medical Center - Maryville

  • Specialist
  • Maryville, MO
  • NPI 1184189797
  Medicare reassignment
• Northwest Missouri State University

  dba NWMSU Wellness Center

  • Student Health Clinic/Center
  • Maryville, MO
  • NPI 1760542567
  NPD (past) Authorized official
• Northwest Medical Center Association, Inc

  dba Mosaic Family Care New Hampton

  • Rural Health Clinic/Center
  • New Hampton, MO
  • NPI 1346599230
  NPD
• Mosaic Medical Center - Maryville

  • Critical Access Hospital
  • Maryville, MO
  • NPI 1265906663
  NPD (past)

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

{
    "created_epoch": "1138406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352419200000",
    "number": "1508837691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 E SOUTH HILLS DR",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682659",
            "telephone_number": "660-562-4304",
            "fax_number": "660-562-4303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 E SOUTH HILLS DR",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682659",
            "telephone_number": "660-562-2525",
            "fax_number": "660-562-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "SUSAN",
        "middle_name": "JANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-28",
        "last_updated": "2012-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "110025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208219816",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East, LP (Vision Center 30-0801)
• Walgreen Co (Walgreens #12821)
• Mikaila Wallace, DO
• Wasif Almuttar,MD,Anes.SVC.,P.C.
• Riley Dale Watkins, ATC, LAT
• Myra Webster, COTA
• Kristi Renee White, L.C.S.W.
• Gerald W Wilmes, MD
• Hayston W Wilson
• Leslie Alitz Wittmann, OD

• Pediatrics Physician in Maryville, MO
• Providers in Maryville, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.