Individual provider Active NPI

Susan Nell Rogers, ANP

  • Pediatric Nurse Practitioner
  • Bryan, TX
National Provider Identifier
1710093216
Registry record updated Jul 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
231641 Issued in TX
Practice address
3370 S Texas Ave
#B
Bryan, TX 77802-3127
Phone
(979) 595-1700
Fax
(979) 595-1740
NPI assigned
Aug 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 231641 TX Primary

Addresses

Primary practice location

3370 S Texas Ave
#B
Bryan, TX 77802-3127

Mailing address

1500 University Dr E
#100
College Station, TX 77840-2600
Phone (979) 846-1100

Other identifiers 7

IdentifierTypeStateIssuer
000951607MedicaidTX
1649265646OtherTXNPI CLINIC B
187842301MedicaidTX
741715140OtherTXTAX ID
1821185299OtherTXNPI AGENCY
154467801MedicaidTX
231641OtherTXTEXAS BOARD NURSING

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Brazos Valley Community Action Agency, Inc. Past Accepting new patients

Organizations & group practices 1

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": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373414400000",
    "number": "1710093216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 UNIVERSITY DR E",
            "address_2": "#100",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778402600",
            "telephone_number": "979-846-1100",
            "fax_number": "979-260-9390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3370 S TEXAS AVE",
            "address_2": "#B",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778023127",
            "telephone_number": "979-595-1700",
            "fax_number": "979-595-1740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "SUSAN",
        "middle_name": "NELL",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2013-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "231641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000951607",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI CLINIC B",
            "identifier": "1649265646",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187842301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "741715140",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI AGENCY",
            "identifier": "1821185299",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154467801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS BOARD NURSING",
            "identifier": "231641",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

Verify at the official NPI Registry.