Individual provider Active NPI

Susan Aye Mya Oo, MD

  • Pediatrics Physician
  • Springfield, IL
National Provider Identifier
1568099299
Registry record updated Jul 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036.179968 Issued in IL
Practice address
400 N 9TH St
Springfield, IL 62702-5310
Phone
(217) 545-8000
Fax
(217) 545-2303
NPI assigned
Mar 24, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 73794 MN
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 036.179968 IL Primary

Addresses

Primary practice location

400 N 9TH St
Springfield, IL 62702-5310

Mailing address

PO Box 19639
Springfield, IL 62794-9639
Phone (217) 545-8000

Other practice location 1

210 9th St SE
Rochester, MN 55904-6756
Phone (507) 288-3443

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20230822000206 MN Practitioner - Pediatric Medicine 4981028057 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
73794MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Olmsted Medical Center CurrentSince Aug 1, 2023 Accepting new patients
Olmsted Medical Center Past Accepting new patients

Locations

210 9th St SE
Rochester, MN 55904
Phone (507) 529-6616

1650 4th St SE
Rochester, MN 55904
Phone (507) 285-8485

Interoperability endpoints

  • Direct secure messaging: soo21814@direct.olmmed.org

Organizations & group practices 2

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": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1568099299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19639",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949639",
            "telephone_number": "217-545-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N 9TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627025310",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-2303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "210 9th St SE",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559046756",
            "country_code": "US",
            "telephone_number": "507-288-3443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OO",
        "first_name": "SUSAN",
        "middle_name": "AYE MYA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-24",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "73794",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036.179968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.