Active NPI
Suzanne K Pierson, PHD
- Clinical Psychologist
- Indianapolis, IN
National Provider Identifier
1679641484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20042142A
- Practice address
- 2001 W 86TH St
Indianapolis, IN 46260-1902 - Phone
- (317) 338-3103
- NPI assigned
- Dec 1, 2006
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20042142A | IN | Primary |
Addresses
Primary practice location
2001 W 86TH St
Indianapolis, IN 46260-1902
Mailing address
1 Childrens PL
Ste 3N-14
Saint Louis, MO 63110-1002
Other practice location 1
1 Childrens PL
Ste 3N-14
Saint Louis, MO 63110-1002
Phone (314) 454-6069
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200842800 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20042142A | IN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SSM Health Care Group | Current | Accepting new patients | |
| SSM Health Care Group | Current | Accepting new patients | |
| St. Louis Childrens Hospital | Past | Accepting new patients |
Locations
1438 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 977-4828
10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647
Interoperability endpoints
- spierson438526@direct-ehr-ssmhc.com
- https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
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.
-
dba SLUCare Physician Group
- Internal Medicine Physician
- Saint Louis, MO
- NPI 1306589544
-
dba SLUCare Physician Group
- Dermatopathology Physician
- Saint Louis, MO
- NPI 1932844495
-
- Pediatrics Physician
- Saint Louis, MO
- NPI 1194246728
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636070400000",
"number": "1679641484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CHILDRENS PL",
"address_2": "STE 3N-14",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 W 86TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462601902",
"telephone_number": "317-338-3103"
}
],
"practiceLocations": [
{
"address_1": "1 CHILDRENS PL",
"address_2": "STE 3N-14",
"address_purpose": "LOCATION",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101002",
"country_code": "US",
"telephone_number": "314-454-6069",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PIERSON",
"first_name": "SUZANNE",
"middle_name": "K",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-01",
"last_updated": "2021-11-05",
"certification_date": "2021-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20042142A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200842800",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"endpointDescription": "BJC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1 CHILDRENS PL",
"address_2": "STE 3N-14",
"city": "SAINT LOUIS",
"state": "MO",
"country_code": "US",
"postal_code": "631101002",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.