Individual provider Active NPI

Megan Delfausse Sutsko, PSYD

  • Psychologist
  • Charlotte, NC
National Provider Identifier
1659664183
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
5586 Issued in NC
Practice address
3541 Randolph Rd
Ste 206
Charlotte, NC 28211-1082
Phone
(704) 381-8336
NPI assigned
May 17, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 5586 NC Primary

Addresses

Primary practice location

3541 Randolph Rd
Ste 206
Charlotte, NC 28211-1082

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

3541 Randolph Rd
Ste 210
Charlotte, NC 28211-1082
Phone (704) 381-8336

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address Ambulatory@direct.carolinashealthcare.org Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191228000247 NC Practitioner - Clinical Psychologist 7315371309 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5586NCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center Psychologist CurrentSince Oct 14, 2019 Accepting new patients
Carolinas Medical Center CurrentSince Oct 14, 2019 Accepting new patients
Carolinas Medical Center Current Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

251 Eastway Dr
Charlotte, NC 28213
Phone (704) 446-9991

3541 Randolph Rd
Ste 210
Charlotte, NC 28211
Phone (704) 381-8336

3541 Randolph Rd
Ste 206
Charlotte, NC 28211
Phone (704) 381-8336

Interoperability endpoints

  • Direct secure messaging: ambulatory@direct.carolinashealthcare.org

Organizations & group practices 3

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": "1305590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1659664183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3541 RANDOLPH RD",
            "address_2": "STE 206",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111082",
            "telephone_number": "704-381-8336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3541 Randolph Rd",
            "address_2": "Ste 210",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282111082",
            "country_code": "US",
            "telephone_number": "704-381-8336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUTSKO",
        "first_name": "MEGAN",
        "middle_name": "DELFAUSSE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-17",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "5586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Ambulatory@direct.carolinashealthcare.org",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "3541 Randolph Rd",
            "address_2": "Ste 206",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282111082",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.