Individual provider Active NPI

Susana Lagunas

  • Family Nurse Practitioner
  • Mishawaka, IN
National Provider Identifier
1619418332
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71006934A Issued in IN
Practice address
420 W 4TH St
Mishawaka, IN 46544-1948
Phone
(574) 307-7673
Fax
(574) 307-7692
NPI assigned
Mar 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

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 71006934A IN Primary

Addresses

Primary practice location

420 W 4TH St
Mishawaka, IN 46544-1948

Mailing address

420 W 4TH St
Mishawaka, IN 46544-1948
Phone (574) 307-7676

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20170324000708 IN Practitioner - Nurse Practitioner 1557646056 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Refresh F5 IncGroup PAC ID 9032622436, 3 clinicians
Healthlinc IncGroup PAC ID 7618929373, 83 clinicians

Practice addresses (Care Compare)

201 S William St
South Bend, IN 46601-2515
Phone (574) 234-2870

420 W 4TH St
Mishawaka, IN 46544-1948
Phone 57430776734693

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healthlinc, Inc. CurrentSince Jan 19, 2022 Accepting new patients
Healthlinc, Inc CurrentSince Jan 19, 2022 Accepting new patients
Healthlinc, Inc. Current Accepting new patients
Healthlinc, Inc Past Accepting new patients

Locations

2323 Broadway St
East Chicago, IN 46312

710 Franklin St
Ste 200
Michigan City, IN 46360
Phone (219) 872-6200

420 W 4th St
Mishawaka, IN 46544
Phone (574) 252-0300

1001 Sturdy Rd
Valparaiso, IN 46383
Phone (219) 462-7173

701 Wall St
Valparaiso, IN 46383
Phone (219) 299-8419

2401 Valley Dr
Valparaiso, IN 46383
Phone (219) 413-5100

Interoperability endpoints

  • Direct secure messaging: susana.lagunas.1@29671.direct.athenahealth.com

Organizations & group practices 5

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": "1489449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1619418332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W 4TH ST",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441948",
            "telephone_number": "574-307-7676",
            "fax_number": "574-307-7692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W 4TH ST",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441948",
            "telephone_number": "574-307-7673",
            "fax_number": "574-307-7692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAGUNAS",
        "first_name": "SUSANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-14",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71006934A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.