Active NPI
Susan Mary Brown, RD
- Registered Dietitian
- Champaign, IL
National Provider Identifier
1720095961
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164003513
- Practice address
- 1813 W Kirby Ave
Champaign, IL 61821-5410 - Phone
- (217) 384-3490
- Fax
- (217) 383-3439
- NPI assigned
- Aug 1, 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164003513 | IL | Primary |
Addresses
Primary practice location
1813 W Kirby Ave
Champaign, IL 61821-5410
Mailing address
611 W. Park St.
BWPC
Urbana, IL 61801-2500
Phone (217) 383-6792
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1002 Medical Ctr Dr
Monticello, IL 61856-2116
Phone (217) 762-2518
1540 E Grove Ave
Rantoul, IL 61866-2736
Phone (217) 893-7700
1701 W Curtis Rd
Champaign, IL 61822-9678
Phone (217) 365-6200
611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Carle Health Care Incorporated | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Internal Medicine Physician
- Urbana, IL
- NPI 1154653947
-
- Durable Medical Equipment & Medical Supplies
- Champaign, IL
- NPI 1114240876
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419552000000",
"number": "1720095961",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 W. PARK ST.",
"address_2": "BWPC",
"city": "URBANA",
"state": "IL",
"postal_code": "618012500",
"telephone_number": "217-383-6792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1813 W KIRBY AVE",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618215410",
"telephone_number": "217-384-3490",
"fax_number": "217-383-3439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "SUSAN",
"middle_name": "MARY",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2014-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164003513",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.