Individual provider Active NPI

Susan K Preslar, FNP

  • Family Nurse Practitioner
  • Medford, OR
National Provider Identifier
1558462507
Registry record updated Mar 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
088006770N1 Issued in OR
Practice address
3156 State St
Medford, OR 97504-8450
Phone
(541) 773-9772
Fax
(541) 773-1113
NPI assigned
Sep 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 088006770N1 OR Primary

Addresses

Primary practice location

3156 State St
Medford, OR 97504-8450

Mailing address

3156 State St
Medford, OR 97504-8450
Phone (541) 773-9772

Other identifiers 1

IdentifierTypeStateIssuer
100366MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040512001135 OR Practitioner - Nurse Practitioner 3678563798 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Complete Integrative Care, LLCGroup PAC ID 0244510261, 7 clinicians

Practice addresses (Care Compare)

3156 State St
Medford, OR 97504-8450
Phone (541) 773-9772

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
088006770N1ORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Complete Integrative Care, LLC CurrentSince Oct 31, 2016 Accepting new patients

Locations

3144 State St
Medford, OR 97504
Phone (541) 772-9355

3156 State St
Medford, OR 97504
Phone (541) 773-9772

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648080000000",
    "number": "1558462507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3156 STATE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048450",
            "telephone_number": "541-773-9772",
            "fax_number": "541-773-1113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3156 STATE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048450",
            "telephone_number": "541-773-9772",
            "fax_number": "541-773-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESLAR",
        "first_name": "SUSAN",
        "middle_name": "K",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "088006770N1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100366",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.