Allen M Sussman, MD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

MD00015978 Issued in WA

Practice address

723 SW 10TH St
Ste 250
Renton, WA 98055

Phone

(425) 656-4040

Fax

(425) 656-4046

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Southlake Clinic Inc PS

  • Clinical Medical Laboratory
  • Renton, WA
  • NPI 1548319171
  NPD (past)
• Southlake Clinic Inc., P.S.

  • Internal Medicine Physician
  • Renton, WA
  • NPI 1104962331

  Endocrinology, Diabetes & Metabolism

  NPD (past)

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260403200000",
    "number": "1710991237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 59028",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980582028",
            "telephone_number": "425-251-5110",
            "fax_number": "425-793-4707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 SW 10TH ST",
            "address_2": "STE 250",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "98055",
            "telephone_number": "425-656-4040",
            "fax_number": "425-656-4046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSSMAN",
        "first_name": "ALLEN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2009-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "WA",
            "license": "MD00015978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0016607",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110202799",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487800",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Supplemental Health Care
• Sushitha Surendran, MD
• Jill Koerselman Suresh, MSW, LSWAIC
• Matthew Salazar Surrusco, M.D.
• Susan Chu DDS PLLC
• Samuel Wroe Sussman, MD
• Debra L Svenvold, LPN
• William Chad Swaims, PA-C
• Swedish Health Services
• Lauri S. Sweeney, AU.D.

• All providers in Renton, WA
• Endocrinology, Diabetes & Metabolism Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 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.

Verify at the official NPI Registry.