Susan M Gibson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

21115 Issued in AL

Practice address

3840 Gault Ave N
Fort Payne, AL 35967-5211

Phone

(256) 844-4975

Fax

(256) 844-4978

NPI assigned

Aug 21, 2006

Sex

Female

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 12

Medicare fee-for-service enrollment

Enrolled in AL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Highlands Hospitalists Services LLC

  • Hospitalist Physician
  • Scottsboro, AL
  • NPI 1154690246
  Medicare reassignment NPD
• Premier Medical Clinic LLC

  • Multi-Specialty Clinic/Center
  • Scottsboro, AL
  • NPI 1083955173
  Medicare reassignment NPD
• Quality of Life Health Services Inc

  • Community Health Clinic/Center
  • Gadsden, AL
  • NPI 1447200977
  Medicare reassignment NPD
• Quality of Life Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Heflin, AL
  • NPI 1467620989
  NPD
• Quality of Life Health Services, Inc.

  • Community Health Clinic/Center
  • Gadsden, AL
  • NPI 1750332243
  NPD
• Whatley Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Tuscaloosa, AL
  • NPI 1063422756
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342742400000",
    "number": "1720194087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 TAYLOR ST",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357682421",
            "telephone_number": "256-259-5313",
            "fax_number": "256-259-4923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 GAULT AVE N",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359675211",
            "telephone_number": "256-844-4975",
            "fax_number": "256-844-4978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "SUSAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2012-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "21115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "051544790",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "051544794",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630308067",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "051544795",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "051544789",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630309067",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "051544791",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630302067",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630303067",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "051544792",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630306067",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630307067",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gadsden Hearing Aid, Inc.
• Lyza Tennille Gaines, CRNP
• Justin Matthew Garmany, RPH
• Sarah Baine Genelin
• General Dentistry and Same Day Denture Clinic,LLC
• Go Play Therapy Center, LLC
• Go Play Therapy, L.L.C.
• Lisa Diane Goldman, P.T., DPT
• Anna Gorham, FNP-C, PMHNP-C
• Joleen Wiener Gorman, MD

• Family Medicine Physician in Fort Payne, AL
• Providers in Fort Payne, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.