Active NPI
Susan L Pereira, MD
- Emergency Medicine Physician
- Columbia, MO
National Provider Identifier
1710932132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- MD106477
- Practice address
- 305 N Keene St
Columbia, MO 65201-6897 - Phone
- (573) 882-8000
- Fax
- (573) 882-6600
- NPI assigned
- May 24, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | MD106477 | MO | Primary |
Addresses
Primary practice location
305 N Keene St
Columbia, MO 65201-6897
Mailing address
PO Box 7687
Columbia, MO 65205-7687
Phone (573) 882-2259
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80114334 | Other | MO | RR MEDICARE |
| 208879205 | Medicaid | MO |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD106477 | MO | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239321600000",
"number": "1710932132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7687",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652057687",
"telephone_number": "573-882-2259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 N KEENE ST",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652016897",
"telephone_number": "573-882-8000",
"fax_number": "573-882-6600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREIRA",
"first_name": "SUSAN",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-24",
"last_updated": "2009-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MO",
"license": "MD106477",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "80114334",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "208879205",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.