Active NPI
Susan Grogan Semmes, CPO/LPO
- Prosthetist
- Valdosta, GA
National Provider Identifier
1528308319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- GA 000004
- Practice address
- 404 Northside Dr
Ste D
Valdosta, GA 31602-1866 - Phone
- (229) 245-8009
- Fax
- (229) 247-2090
- NPI assigned
- Feb 15, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotist | 222Z00000X | GA 000004 | GA | |
| Prosthetist | 224P00000X | GA 000004 | GA | Primary |
Addresses
Primary practice location
404 Northside Dr
Ste D
Valdosta, GA 31602-1866
Mailing address
404 Northside Dr
Ste D
Valdosta, GA 31602-1866
Phone (229) 245-8009
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000690852A | Medicaid | GA | |
| C15505 | Other | GA | BOC CPO |
| LPO 000004 | Other | GA | GEORGIA LICENSE |
| CPO02244 | Other | GA | ABC CPO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GA 000004 | GA | MD | Orthotist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peachstate Prosthetics and Orthotics, Inc | Prosthetist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Prosthetic/Orthotic Supplier
- Blairsville, GA
- NPI 1003810748
Prosthetist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360886400000",
"number": "1528308319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 NORTHSIDE DR",
"address_2": "STE D",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021866",
"telephone_number": "229-245-8009",
"fax_number": "229-247-2090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 NORTHSIDE DR",
"address_2": "STE D",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021866",
"telephone_number": "229-245-8009",
"fax_number": "229-247-2090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEMMES",
"first_name": "SUSAN",
"middle_name": "GROGAN",
"credential": "CPO/LPO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-02-15",
"last_updated": "2013-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "GA",
"license": "GA 000004",
"primary": false
},
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "GA",
"license": "GA 000004",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000690852A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOC CPO",
"identifier": "C15505",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA LICENSE",
"identifier": "LPO 000004",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ABC CPO",
"identifier": "CPO02244",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.