Joel M Suckow-MD, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

OR MD28195 Issued in OR

Legal business name

JOEL M SUCKOW-MD, LLC

Practice address

773 Linda Ave NE
Keizer, OR 97303-4549

Phone

(971) 808-2854

Fax

(888) 256-7959

NPI assigned

Sep 21, 2016

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracy Gonzalez

Title

Credentialing Manager

Phone

(541) 941-7792

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joel M Suckow, M.D.

  • Psychiatry Physician
  • Keizer, OR
  • NPI 1639333727
  NPD

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

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1700335536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "773 LINDA AVE NE",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973034549",
            "telephone_number": "503-585-7454",
            "fax_number": "888-256-7959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "773 LINDA AVE NE",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973034549",
            "telephone_number": "971-808-2854",
            "fax_number": "888-256-7959"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1215 SW G St",
            "address_purpose": "LOCATION",
            "city": "Grants Pass",
            "state": "OR",
            "postal_code": "975262544",
            "country_code": "US",
            "telephone_number": "541-476-2373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JOEL M SUCKOW-MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-21",
        "last_updated": "2023-03-07",
        "certification_date": "2020-12-11",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "541-941-7792"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "OR MD28195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON STATE LICNESE",
            "identifier": "OR MD28195",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joel A. James, PA
• Jay A Jamieson, MD
• Jean Jarbath
• Karina Marie Jarvela, N.D.
• Jeffery W. Baker D.C. P.C. (Back to Health Clinic)
• Janelle Johnson
• Deborah Munnah Jones-Nah, PMHNP
• Carolyn Louise Jones
• Kelly Jones
• Cambria Ann Jordan

• Community/Behavioral Health Agency in Keizer, OR
• Providers in Keizer, OR by specialty
• Community/Behavioral Health Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.