Active NPI
Susan M Forman, CRNA
- Specialist
- Dallas, TX
National Provider Identifier
1710101787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 236864
- Practice address
- 8305 Walnut Hill LN
Suite 210
Dallas, TX 75231-4217 - Phone
- (214) 363-2575
- Fax
- (214) 363-3665
- NPI assigned
- Apr 12, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 236864 | TX | Primary |
Addresses
Primary practice location
8305 Walnut Hill LN
Suite 210
Dallas, TX 75231-4217
Mailing address
8305 Walnut Hill LN
Suite 210
Dallas, TX 75231-4217
Phone (214) 363-2575
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 236864 | TX | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710101787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8305 WALNUT HILL LN",
"address_2": "SUITE 210",
"city": "DALLAS",
"state": "TX",
"postal_code": "752314217",
"telephone_number": "214-363-2575",
"fax_number": "214-363-3665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8305 WALNUT HILL LN",
"address_2": "SUITE 210",
"city": "DALLAS",
"state": "TX",
"postal_code": "752314217",
"telephone_number": "214-363-2575",
"fax_number": "214-363-3665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMAN",
"first_name": "SUSAN",
"middle_name": "M",
"credential": "CRNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TX",
"license": "236864",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.