NPIMap

Individual provider Active NPI

Michael Su, MD

  • Student in an Organized Health Care Education/Training Program
  • Williamsport, PA
National Provider Identifier
1639707326
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
10 Wisteria LN
Williamsport, PA 17701-4188
Phone
(215) 620-8523
NPI assigned
Mar 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

10 Wisteria LN
Williamsport, PA 17701-4188

Mailing address

175 Pine St Ste 200
Williamsport, PA 17701-6549

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20231003002526 PA Practitioner - Family Practice 6103270517 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Susquehanna Physician ServicesGroup PAC ID 2264336460, shared by 32 NPIs, 611 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

1 Outlet LN
Suite 400
Lock Haven, PA 17745-7815
Phone (570) 769-1300

175 Pine St
Suite 200
Williamsport, PA 17701-6549
Phone (570) 326-2447

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

900 Plaza Dr
Montoursville, PA 17754-2448
Phone (570) 368-3321

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.06 of 100Reported as group
Quality
62.07
Promoting interoperability
100
Improvement activities
40
Cost
74.81

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Susquehanna Physician Services CurrentSince Sep 23, 2023 Accepting new patients
Susquehanna Physician Services CurrentSince Sep 23, 2023 Accepting new patients
Susquehanna Physician Services CurrentSince Aug 7, 2024 Accepting new patients
Susquehanna Physician Services CurrentSince Jun 2, 2025 Accepting new patients

Locations

1 Outlet Ln
Ste 400
Lock Haven, PA 17745
Phone (570) 326-8080

610 High St
Lock Haven, PA 17745
Phone (570) 748-1260

900 Plaza Dr
Montoursville, PA 17754
Phone (570) 321-2545

10 Shady Ln
Ste 101
Muncy, PA 17756
Phone (570) 546-4059

1201 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8723

175 Pine St
Ste 200
Williamsport, PA 17701
Phone (570) 326-2447

700 High St
Williamsport, PA 17701
Phone (570) 321-1000

Interoperability endpoints

  • Direct secure messaging: msu244530@upmc.direct-ci.com
  • Direct secure messaging: michael.su@upmcdirect.com

Organizations & group practices 4

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.

Hospital & facility affiliations 38

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1639707326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 PINE ST STE 200",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WISTERIA LN",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177014188",
            "telephone_number": "215-620-8523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SU",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-30",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.