Active NPI
Susan M. Lichtenberger, M.D.
- Pediatrics Physician
- Russell, KY
National Provider Identifier
1629121850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 29626
- Practice address
- 105 Thompson Rd
Russell, KY 41169-1645 - Phone
- (606) 833-8480
- NPI assigned
- Jan 19, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 29626 | KY | Primary |
Addresses
Primary practice location
105 Thompson Rd
Russell, KY 41169-1645
Mailing address
105 Thompson Rd
Russell, KY 41169-1645
Phone (606) 833-8480
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64296262 | Medicaid | KY | |
| 0918645 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29626 | KY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bellefonte Physician Services, Inc. | Past | Accepting new patients | |
| Professional Pediatrics, PSC | Pediatrics | Past | Accepting new patients |
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.
-
- Family Nurse Practitioner
- Wheelersburg, OH
- NPI 1346625795
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346025600000",
"number": "1629121850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 THOMPSON RD",
"city": "RUSSELL",
"state": "KY",
"postal_code": "411691645",
"telephone_number": "606-833-8480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 THOMPSON RD",
"city": "RUSSELL",
"state": "KY",
"postal_code": "411691645",
"telephone_number": "606-833-8480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICHTENBERGER",
"first_name": "SUSAN",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-19",
"last_updated": "2012-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "KY",
"license": "29626",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64296262",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0918645",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Russell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.