Susan Saina Stubbs, CRNP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R187931 Issued in MD

Practice address

954 Forrest St
Baltimore, MD 21202-4236

Phone

(410) 230-1542

NPI assigned

Jun 25, 2018

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

Other names 1

• Susan Saina Otondo Former name

Medicare fee-for-service enrollment

Enrolled in MD

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Proactive Health Services LLC

  • Family Nurse Practitioner
  • Nottingham, MD
  • NPI 1972333946
  Medicare reassignment NPD Authorized official
• Baltimore Medical System, Inc.

  dba BMS@Yard56

  • Federally Qualified Health Center (FQHC)
  • Baltimore, MD
  • NPI 1164138152
  Medicare reassignment NPD
• Proactive Care LLC

  • Family Nurse Practitioner
  • Nottingham, MD
  • NPI 1487492781
  NPD Authorized official
• Baltimore Medical System, Inc.

  • Federally Qualified Health Center (FQHC)
  • Baltimore, MD
  • NPI 1700882503
  NPD

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529884800000",
    "number": "1710472527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5017 TARTAN HILL RD",
            "city": "PERRY HALL",
            "state": "MD",
            "postal_code": "211289639",
            "telephone_number": "443-902-6314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "954 FORREST ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212024236",
            "telephone_number": "410-230-1542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUBBS",
        "first_name": "SUSAN",
        "middle_name": "SAINA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-25",
        "last_updated": "2018-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "R187931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "OTONDO",
            "middle_name": "SAINA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bradley Charles Strunk, M.D.
• George Franklin Strutt, PHD
• Justine Sydney Thompson Stryker
• Susan Eileen Stuart, PMHNP
• Yolandi Stuart
• Asjah Stuckey
• Courtney Stuckey
• Joseph Edward Stucky
• Nihal David Studden
• Kimberley Studeman, M.D.

• Family Medicine Physician in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.