Active NPI
Susan Hendren, CNM
- Advanced Practice Midwife
- Boise, ID
National Provider Identifier
1629593165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- 72994
- Practice address
- 1072 N Liberty St Ste 100
Boise, ID 83704-8708 - Phone
- (208) 302-1200
- Fax
- (208) 302-1255
- NPI assigned
- Aug 6, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | |||
| Advanced Practice Midwife | 367A00000X | 72994 | ID | Primary |
Addresses
Primary practice location
1072 N Liberty St Ste 100
Boise, ID 83704-8708
Mailing address
3340 E Goldstone Dr
Meridian, ID 83642-1026
Phone (208) 302-9342
Other practice location 1
177 McNabb Rd
Moriarty, NM 87035-5433
Phone (505) 917-6829
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180202001634 | TX | Practitioner - Certified Nurse Midwife (CNM) | 2466712864 | Reassigns benefits to 3 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Certified Nurse Midwife (CNM)
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pine Ridge Indian Health Service Hospital
Practice addresses (Care Compare)
1000 Health Ctr Rd
Kyle, SD 57752-0540
Phone (604) 455-2451
Hospital & facility affiliations
- Pine Ridge IHS Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72994 | ID | MD | Advanced Practice Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Ridge Indian Health Service Hospital | Current | Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Current | Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Current | Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Current | Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Current | Accepting new patients | |
| Saint Alphonsus Regional Medical Center Inc | Past | Accepting new patients |
Locations
119 S 1st Ave
Martin, SD 57551
Phone (605) 685-2800
Interoperability endpoints
- shendren2049789@direct.trinity-health.org
Organizations & group practices 6
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.
-
- General Acute Care Hospital
- Pine Ridge, SD
- NPI 1497786412
TX
-
- Clinic/Center
- Martin, SD
- NPI 1003208257
-
- Clinic/Center
- Manderson, SD
- NPI 1487701348
-
- General Acute Care Hospital
- Boise, ID
- NPI 1992736649
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Pine Ridge, SD
- NPI 1497786412
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655337600000",
"number": "1629593165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 E GOLDSTONE DR",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836421026",
"telephone_number": "208-302-9342",
"fax_number": "208-367-5180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1072 N LIBERTY ST STE 100",
"city": "BOISE",
"state": "ID",
"postal_code": "837048708",
"telephone_number": "208-302-1200",
"fax_number": "208-302-1255"
}
],
"practiceLocations": [
{
"address_1": "177 McNabb Rd",
"address_purpose": "LOCATION",
"city": "Moriarty",
"state": "NM",
"postal_code": "870355433",
"country_code": "US",
"telephone_number": "505-917-6829",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HENDREN",
"first_name": "SUSAN",
"name_prefix": "Mrs.",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-06",
"last_updated": "2022-06-16",
"certification_date": "2022-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": null,
"license": null,
"primary": false
},
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "ID",
"license": "72994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.