Susamma Thomas Idicula, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F305565-1 Issued in NY

Practice address

120 West 106 Street
The Jewish Home & Hospital
New York, NY 10025-0000

Phone

(212) 870-5000

Fax

(212) 870-4905

NPI assigned

Mar 22, 2011

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

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Jewish Home Lifecare, Manhattan

  • Geriatric Medicine (Internal Medicine) Physician
  • New York, NY
  • NPI 1639244742
  Medicare reassignment NPD
• Jewish Home Lifecare, Manhattan

  • Long Term Care Pharmacy
  • New York, NY
  • NPI 1356434781
  NPD

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

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300752000000",
    "number": "1720387343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W 106TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100253923",
            "telephone_number": "212-870-5000",
            "fax_number": "212-870-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 WEST 106 STREET",
            "address_2": "THE JEWISH HOME & HOSPITAL",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100250000",
            "telephone_number": "212-870-5000",
            "fax_number": "212-870-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDICULA",
        "first_name": "SUSAMMA",
        "middle_name": "THOMAS",
        "name_prefix": "Mrs.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-22",
        "last_updated": "2011-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F305565-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Icl-East New York Prevention-Based Satellite
• Ida'S Homecare Agency Inc.
• Samantha Idan, LMSW
• Ashleigh Ide
• Ideal Idtf Services of New York, Inc.
• Idil Ozturk Psychotherapy LCSW PLLC
• Sana Idnani
• Caitlin Idoine
• Sarah Idowu
• Teniola Idowu

• Adult Health Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; 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.