NPIMap

Individual provider Active NPI

Susan Yanik

  • Otolaryngology Physician
  • Concord, NC
National Provider Identifier
1700206307
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
2020-02127 Issued in NC
Practice address
645 Amalia St NE
Concord, NC 28025-2434
Phone
(704) 295-3255
Fax
(704) 295-7791
NPI assigned
Apr 22, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Otolaryngology Physician 207Y00000X 2020-02127 NC Primary

Addresses

Primary practice location

645 Amalia St NE
Concord, NC 28025-2434

Mailing address

645 Amalia St NE
Concord, NC 28025-2434
Phone (704) 295-3255

Other practice location 1

750 E Adams St
Syracuse, NY 13210-2306
Phone (315) 464-4678

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address syanikmd34514@direct.ceenta.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200824000039 NC Practitioner - Otolaryngology 7517205990 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Southern Illinois University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proactive Therapy of North Carolina IncGroup PAC ID 6305753120, shared by 5 NPIs, 540 clinicians

Practice addresses (Care Compare)

201 McCullough Dr
Suite 310
Charlotte, NC 28262-3577
Phone (704) 547-1129

645 Amalia St NE
Concord, NC 28025-2434
Phone (704) 295-3255

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Charlotte Eye Ear Nose & Throat Associates, P.a. Otolaryngology CurrentSince Sep 8, 2020 Accepting new patients
Charlotte Eye Ear Nose & Throat Associates, PA CurrentSince Sep 8, 2020 Accepting new patients

Locations

6035 Fairview Rd
Charlotte, NC 28210
Phone (336) 718-2078

645 Amalia St NE
Concord, NC 28025
Phone (704) 295-3255

10305 Hamptons Park Dr
Ste 201
Huntersville, NC 28078
Phone (704) 295-3600

Interoperability endpoints

  • Direct secure messaging: syanikmd34514@direct.ceenta.com

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 9

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": "1398124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1700206307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 AMALIA ST NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252434",
            "telephone_number": "704-295-3255",
            "fax_number": "704-295-7791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 AMALIA ST NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252434",
            "telephone_number": "704-295-3255",
            "fax_number": "704-295-7791"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 E Adams St",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132102306",
            "country_code": "US",
            "telephone_number": "315-464-4678",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YANIK",
        "first_name": "SUSAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-22",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "2020-02127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "syanikmd34514@direct.ceenta.com",
            "affiliation": "N",
            "address_1": "645 Amalia St NE",
            "city": "Concord",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280252434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.