Promporn June Suwanabol

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

3398-23 Issued in WI

Practice address

123 Hospital Dr
Suite 2009
Watertown, WI 53098-3331

Phone

(920) 262-9833

NPI assigned

Jul 30, 2014

Last updated

Dec 16, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Watertown Physician Practices LLCGroup PAC ID 8022329408, 64 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Commonheart Home Health Home health agency, Waukesha, WI, CCN 527151
• Rainbow Hospice Care Hospice, Jefferson, WI, CCN 521555
• Agrace Hospicecare Hospice, Madison, WI, CCN 521505
• Watertown Memorial Hospital Hospital, Watertown, WI, CCN 520116
• Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: promporn.suwanabol.1@17022.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Watertown Physician Practices LLC

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1770964363
  Medicare reassignment Care Compare group NPD
• Watertown Physician Practices LLC

  • Obstetrics & Gynecology Physician
  • Watertown, WI
  • NPI 1225412265
  NPD

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

• Agrace Hospicecare, Incorporated

  • Community Based Hospice Care Agency
  • Fitchburg, WI
  • NPI 1861503534
  Care Compare affiliation
• Commonheart, Inc.

  dba CommonHeart Home Health

  • Home Health Agency
  • Waukesha, WI
  • NPI 1629071121
  Care Compare affiliation
• Prohealth Waukesha Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Waukesha, WI
  • NPI 1629056890
  Care Compare affiliation
• Rainbow Hospice Care, Inc.

  dba Rainbow Community Care

  • Community Based Hospice Care Agency
  • Jefferson, WI
  • NPI 1538134499
  Care Compare affiliation
• Watertown Medical Center LLC

  dba Watertown Regional Medical Center

  • General Acute Care Hospital
  • Watertown, WI
  • NPI 1992776041
  Care Compare affiliation

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

{
    "created_epoch": "1406678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418688000000",
    "number": "1710395058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 HOSPITAL DR",
            "address_2": "SUITE 2009",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983331",
            "telephone_number": "920-262-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 HOSPITAL DR",
            "address_2": "SUITE 2009",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983331",
            "telephone_number": "920-262-9833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUWANABOL",
        "first_name": "PROMPORN",
        "middle_name": "JUNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-30",
        "last_updated": "2014-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "3398-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael E Sullivan, M.D.
• Sheila Kerri Sullivan, D.O.
• Jeffrey Sundberg, D.D.S.
• Mary Supple, LPN
• Meghan Marie Supple
• Zachary Thomas Sweatman, ATC
• Bethann Marie Swisher, PHARMD
• Kenneth Russell Tennessen, PHARMD
• Kimberly Ann Theisen, PTS
• Jarrod Bruce Thomas, DDS

• Medical Physician Assistant in Watertown, WI
• Providers in Watertown, WI by specialty
• Medical Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.