Individual provider Active NPI

Susan D Ernst, MD

  • Obstetrics & Gynecology Physician
  • Ann Arbor, MI
National Provider Identifier
1720140023
Registry record updated Apr 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
4301061884 Issued in MI
Practice address
1500 East Medical Center Dr
9TH Floor Recp B
Ann Arbor, MI 48109-4276
Phone
(734) 763-6295
NPI assigned
Dec 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 4301061884 MI Primary

Addresses

Primary practice location

1500 East Medical Center Dr
9TH Floor Recp B
Ann Arbor, MI 48109-4276

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 1

IdentifierTypeStateIssuer
4166070MedicaidMI

Other names 1

  • Susan Dwyer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100320000043 MI Practitioner - Obstetrics/Gynecology 7719012434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Michigan Medical School, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

207 Fletcher St
Ann Arbor, MI 48109-1050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301061884MIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan-Uhs-University Health Ser CurrentSince Aug 26, 2002 Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

207 Fletcher St
Rm 245G
Ann Arbor, MI 48109
Phone (734) 763-9631

207 Fletcher St
Ann Arbor, MI 48109
Phone (734) 764-8320

207 Fletcher St
Rm 0
Ann Arbor, MI 48109

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333497600000",
    "number": "1720140023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DR",
            "address_2": "9TH FLOOR RECP B",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481094276",
            "telephone_number": "734-763-6295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERNST",
        "first_name": "SUSAN",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-14",
        "last_updated": "2012-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "4301061884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4166070",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "DWYER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.