Individual provider Active NPI

Susan Patricia Heinrich, M.D.

  • Family Medicine Physician
  • South Haven, MI
National Provider Identifier
1699887125
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
055672 Issued in MI
Practice address
930 Blue Star Hwy
South Haven, MI 49090-7758
Phone
(269) 637-1115
Fax
(269) 639-1314
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 055672 MI Primary

Addresses

Primary practice location

930 Blue Star Hwy
South Haven, MI 49090-7758

Mailing address

930 Blue Star Hwy
South Haven, MI 49090-7758
Phone (269) 637-1115

Other identifiers 6

IdentifierTypeStateIssuer
5253094OtherMIAETNA
080H06004OtherMIBCBSM
2647288MedicaidMI
P53525OtherMIBCN
0131170OtherMIPHP/IBA
080027375OtherMIRR MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100717000067 MI Practitioner - Family Practice 4981760410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Chicago, Pritzker School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bronson Lakeview HospitalGroup PAC ID 9032008495, 72 clinicians

Practice addresses (Care Compare)

930 Blue Star Hwy
South Haven, MI 49090-7758
Phone (269) 637-1115

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
055672MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson Lakeview Hospital Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Bronson Lakeview Hospital CurrentSince Jul 1, 2022 Accepting new patients

Locations

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

451 Health Pkwy
Paw Paw, MI 49079
Phone (269) 655-1725

930 Blue Star Hwy
South Haven, MI 49090
Phone (269) 637-1115

950 S Bailey Ave
South Haven, MI 49090
Phone (269) 639-2796

Interoperability endpoints

  • Direct secure messaging: sheinrich97610@direct.bronsonhg.org
  • Direct secure messaging: direct@direct.bronsonhg.org

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 and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1699887125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 BLUE STAR HWY",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490907758",
            "telephone_number": "269-637-1115",
            "fax_number": "269-639-1314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 BLUE STAR HWY",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490907758",
            "telephone_number": "269-637-1115",
            "fax_number": "269-639-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINRICH",
        "first_name": "SUSAN",
        "middle_name": "PATRICIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "055672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5253094",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "080H06004",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2647288",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "P53525",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP/IBA",
            "identifier": "0131170",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080027375",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Haven, MI

Sources for this page

Verify at the official NPI Registry.