Individual provider Active NPI

Maria Aurora Canlas Sucgang, MD

  • Pediatrics Physician
  • Enterprise, AL
National Provider Identifier
1528049863
Registry record updated Mar 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
22576 Issued in AL
Practice address
101 Professional LN
Enterprise, AL 36330-2085
Phone
(334) 347-3404
Fax
(334) 393-0613
NPI assigned
Nov 11, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 22576 AL Primary

Addresses

Primary practice location

101 Professional LN
Enterprise, AL 36330-2085

Mailing address

101 Professional LN
Enterprise, AL 36330-2085
Phone (334) 347-3404

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20110802000043 AL Practitioner - Pediatric Medicine 6002085453 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
22576ALMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Houston County Healthcare Authority Pediatrics CurrentSince Jul 11, 2011 Accepting new patients
Houston County Healthcare Authority Current Accepting new patients
Houston County Healthcare Authority CurrentSince Jul 11, 2011 Accepting new patients
Houston County Healthcare Authority Current Accepting new patients
Southeast Alabama Medical Center Employee Pharmacy Past Accepting new patients

Locations

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

1118 Ross Clark Cir
Ste 500
Dothan, AL 36301
Phone (334) 794-4159

101 Professional Ln
Enterprise, AL 36330
Phone (334) 347-3404

Interoperability endpoints

  • Direct secure messaging: msucgang14467@southeasthealth.direct-ci.com

Organizations & group practices 5

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": "1131667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331164800000",
    "number": "1528049863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PROFESSIONAL LN",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302085",
            "telephone_number": "334-347-3404",
            "fax_number": "334-393-0613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PROFESSIONAL LN",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302085",
            "telephone_number": "334-347-3404",
            "fax_number": "334-393-0613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUCGANG",
        "first_name": "MARIA AURORA",
        "middle_name": "CANLAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-11",
        "last_updated": "2012-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "22576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enterprise, AL

Sources for this page

Verify at the official NPI Registry.