Susan Lippold, M.D.
Individual provider Active NPI Internal Medicine Physician · Polacca, AZ
NPI 1659597284 · NPPES record last updated Sep 23, 2009
Key facts
- NPI
- 1659597284
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 036-102153 (IL)
- Practice address
- Hwy 264, MP 388
Hopi Health Care Center
Polacca, AZ 86042 - Phone
- (928) 737-6000
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230410000902 | GA | Order and Referring Only - Internal Medicine |
2062574783 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-102153 | IL | MD | Internal Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036-102153 | IL | Yes |
Addresses
Primary practice location
Hwy 264, MP 388
Hopi Health Care Center
Polacca, AZ 86042
Mailing address
P.O. Box 4000
Hopi Health Care Center/Keams Canyon S.U.
Polacca, AZ 86042
Phone (928) 737-6000
Other providers in Polacca, AZ
- Nancy Kramer
- Stanley Kurley Jr.
- Erica Lalo
- Han Le
- Anna Klaertje Lewis
- Marti E. Loew
- Troy Leon Lomavaya
- Beth L Love
- Daniel C Lyons
- Delilah Grace Maldonado
All providers in Polacca, AZ · Internal Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.