Individual provider Active NPI

Suzanne K Pierson, PHD

  • Clinical Psychologist
  • Indianapolis, IN
National Provider Identifier
1679641484
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20042142A Issued in IN
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

Updated by the provider on Nov 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
200842800MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160318001848 MO Practitioner - Clinical Psychologist 4587768379 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20042142AINMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care Group CurrentSince Nov 1, 2022 Accepting new patients
SSM Health Care Group CurrentSince Nov 1, 2022 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

  • Direct secure messaging: spierson438526@direct-ehr-ssmhc.com
  • FHIR API: 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.

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

Verify at the official NPI Registry.