NPIMap

Individual provider Active NPI

Susan Kasko

  • Family Medicine Physician
  • Coloma, MI
National Provider Identifier
1609219070
Registry record updated Oct 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101022893 Issued in MI
Practice address
6701 Paw Paw Ave
Coloma, MI 49038-9519
Phone
(269) 463-3600
Fax
(269) 468-3334
NPI assigned
Apr 16, 2013
Last updated
Oct 20, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 5101022893 MI Primary

Addresses

Primary practice location

6701 Paw Paw Ave
Coloma, MI 49038-9519

Mailing address

6701 Paw Paw Ave
Coloma, MI 49038-9519
Phone (269) 463-3600

Other identifiers 1

IdentifierTypeStateIssuer
1609219070MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161025002180 MI Practitioner - Family Practice 6901030535 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6701 Paw Paw Ave
Coloma, MI 49038-9519
Phone (269) 463-3600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101022893MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Community Hospital Watervliet Family Medicine Current Accepting new patients
Lakeland Community Hospital Watervliet Family Medicine CurrentSince Nov 14, 2016 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Nov 14, 2016 Accepting new patients

Locations

6701 Paw Paw Ave
Coloma, MI 49038
Phone (269) 468-6430

400 Medical Park Dr
Watervliet, MI 49098
Phone (269) 463-3111

Interoperability endpoints

  • FHIR API: https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/
  • Direct secure messaging: skasko1270219@epic00.corewelldirect.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1366070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476921600000",
    "number": "1609219070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 PAW PAW AVE",
            "city": "COLOMA",
            "state": "MI",
            "postal_code": "490389519",
            "telephone_number": "269-463-3600",
            "fax_number": "269-468-3334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 PAW PAW AVE",
            "city": "COLOMA",
            "state": "MI",
            "postal_code": "490389519",
            "telephone_number": "269-463-3600",
            "fax_number": "269-468-3334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASKO",
        "first_name": "SUSAN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-16",
        "last_updated": "2016-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101022893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609219070",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coloma, MI

Sources for this page

Verify at the official NPI Registry.