Individual provider Active NPI

Suzanne Cotter

  • Internal Medicine Physician
  • Pottsville, PA
National Provider Identifier
1609804137
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD469554 Issued in PA
Practice address
106 S Claude a Blvd
Pottsville, PA 17901-3639
Phone
(570) 728-2424
Fax
(570) 728-2425
NPI assigned
Jun 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X D0054995 MD
Internal Medicine Physician 207R00000X MD469554 PA Primary

Addresses

Primary practice location

106 S Claude a Blvd
Pottsville, PA 17901-3639

Mailing address

2100 Mack Blvd FL 4
Allentown, PA 18103-5622
Phone (570) 501-6368

Other identifiers 3

IdentifierTypeStateIssuer
022004300MedicaidMD
103982530-0001MedicaidPA
536403500MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20220214000878 PA Practitioner - Internal Medicine 3971996042 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0054995MDMDEmergency Medicine Physician
MD469554PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Schuylkill Health System Medical Group, Inc. Internal Medicine CurrentSince Jan 1, 2022 Accepting new patients
Schuylkill Health System Medical Group, Inc. Emergency Medicine CurrentSince Jan 1, 2022 Accepting new patients
Johns Hopkins Emergency Medical Past Accepting new patients

Locations

2100 Mack Blvd
Fl 4
Allentown, PA 18103

700 Schuylkill Manor Rd
Ste 3
Pottsville, PA 17901
Phone (570) 621-4440

106 S Claude a Lord Blvd
Pottsville, PA 17901
Phone (570) 622-4209

200 Schuylkill Medical Plz
Pottsville, PA 17901
Phone (570) 621-9200

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1609804137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 MACK BLVD FL 4",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181035622",
            "telephone_number": "570-501-6368",
            "fax_number": "570-501-4754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 S CLAUDE A BLVD",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013639",
            "telephone_number": "570-728-2424",
            "fax_number": "570-728-2425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COTTER",
        "first_name": "SUZANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MD",
            "license": "D0054995",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD469554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022004300",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103982530-0001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "536403500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pottsville, PA

Sources for this page

Verify at the official NPI Registry.