Active NPI
Susan K Henry, MD
- Internal Medicine Physician
- Free Soil, MI
National Provider Identifier
1720025042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301042734
- Practice address
- 6050 N US Highway 31
Free Soil, MI 49411-9157 - Phone
- (231) 757-1260
- Fax
- (231) 757-1261
- NPI assigned
- Jun 2, 2006
- Last updated
- Apr 1, 2016
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301042734 | MI | Primary |
Addresses
Primary practice location
6050 N US Highway 31
Free Soil, MI 49411-9157
Mailing address
6050 N US Highway 31
Free Soil, MI 49411-9157
Phone (231) 757-1260
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4375777 | Medicaid | MI | |
| 0530023 | Other | MI | BLUE CROSS BLUE SHIELD |
| CJ9804 | Other | MI | RAILROAD MEDICARE GBA PIN |
| 383322171 | Other | MI | TAX ID |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Mi. Regional Cancer and Blood Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Hematology & Oncology Physician
- Free Soil, MI
- NPI 1962449116
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459468800000",
"number": "1720025042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6050 N US HIGHWAY 31",
"city": "FREE SOIL",
"state": "MI",
"postal_code": "494119157",
"telephone_number": "231-757-1260",
"fax_number": "231-757-1261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6050 N US HIGHWAY 31",
"city": "FREE SOIL",
"state": "MI",
"postal_code": "494119157",
"telephone_number": "231-757-1260",
"fax_number": "231-757-1261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRY",
"first_name": "SUSAN",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-02",
"last_updated": "2016-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301042734",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4375777",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0530023",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE GBA PIN",
"identifier": "CJ9804",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "383322171",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Free Soil, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.