NPIMap

Individual provider Active NPI

Mark L Su, M.D.

  • Family Medicine Physician
  • Newburyport, MA
National Provider Identifier
1609871946
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
216973 Issued in MA
Practice address
255 Low St Ste 202
Newburyport, MA 01950
Phone
(978) 225-0378
NPI assigned
Jun 14, 2005
Last updated
Oct 11, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 216973 MA Primary

Addresses

Primary practice location

255 Low St Ste 202
Newburyport, MA 01950

Mailing address

59 Washington St
Newburyport, MA 01950-2306

Other practice location 1

65 Newburyport Tpke
Newbury, MA 01951-1113
Phone (978) 465-9770

Other practice location 2

255 Low St Ste 202
Newburyport, MA 01950
Phone (978) 225-0378

Other identifiers 1

IdentifierTypeStateIssuer
2011450MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20061018000105 MA Practitioner - Family Practice 0547266355 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

255 Low St
Suite 303
Newburyport, MA 01950-3594
Phone (978) 225-0378

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
216973MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Family Practice Family Medicine PastSince Mar 30, 2010 Accepting new patients
Labell & Associates Physical Therapy PastSince Jan 1, 2017 Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/31629/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/3438/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/55881
  • Direct secure messaging: mark.su.1@8421.direct.athenahealth.com

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 5

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": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1609871946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 WASHINGTON ST",
            "city": "NEWBURYPORT",
            "state": "MA",
            "postal_code": "019502306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 LOW ST STE 202",
            "city": "NEWBURYPORT",
            "state": "MA",
            "postal_code": "01950",
            "telephone_number": "978-225-0378"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "65 Newburyport Tpke",
            "address_purpose": "LOCATION",
            "city": "Newbury",
            "state": "MA",
            "postal_code": "019511113",
            "country_code": "US",
            "telephone_number": "978-465-9770",
            "fax_number": "978-465-9004",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "255 Low St Ste 202",
            "address_purpose": "LOCATION",
            "city": "Newburyport",
            "state": "MA",
            "postal_code": "01950",
            "country_code": "US",
            "telephone_number": "978-225-0378",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SU",
        "first_name": "MARK",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "216973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2011450",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburyport, MA

Sources for this page

Verify at the official NPI Registry.