Active NPI
Susan Clair Carpenter, D.O.
- Psychiatry Physician
- Twin Falls, ID
National Provider Identifier
1689631350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- O-335
- Practice address
- 414 Shoup Ave W
Suite B
Twin Falls, ID 83301-5042 - Phone
- (208) 814-9100
- Fax
- (208) 814-9903
- NPI assigned
- Apr 27, 2006
- Last updated
- Dec 9, 2014
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | O-335 | ID | Primary |
Addresses
Primary practice location
414 Shoup Ave W
Suite B
Twin Falls, ID 83301-5042
Mailing address
PO Box 587
Twin Falls, ID 83303-0587
Phone (208) 814-7400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01019576 | Other | ID | MCRR |
| 1689631350 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O-335 | ID | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Magic Valley Regional Medical Center | Past | Accepting new patients | |
| St Luke's Magic Valley Regional Medical Center LTD | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Psychiatric Hospital
- Twin Falls, ID
- NPI 1447208947
-
dba St Lukes Retail Pharmacy Twin Falls
- Community/Retail Pharmacy
- Twin Falls, ID
- NPI 1760203921
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418083200000",
"number": "1689631350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 587",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833030587",
"telephone_number": "208-814-7400",
"fax_number": "208-814-7491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414 SHOUP AVE W",
"address_2": "SUITE B",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833015042",
"telephone_number": "208-814-9100",
"fax_number": "208-814-9903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARPENTER",
"first_name": "SUSAN",
"middle_name": "CLAIR",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-27",
"last_updated": "2014-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "ID",
"license": "O-335",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCRR",
"identifier": "P01019576",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1689631350",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Twin Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.