Active NPI
Susan Ellen Merrill, PA-C
- Physician Assistant
- Charlotte, NC
National Provider Identifier
1760462485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1016582
- Practice address
- 6911-100 Shannon Willow Rd
Charlotte, NC 28226 - Phone
- (704) 529-4101
- Fax
- (704) 529-6655
- NPI assigned
- Jan 19, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1016582 | NC | Primary |
Addresses
Primary practice location
6911-100 Shannon Willow Rd
Charlotte, NC 28226
Mailing address
6911-100 Shannon Willow Rd
Charlotte, NC 28226
Phone (704) 529-4101
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8101095 | Medicaid | NC | |
| 1016582 | Other | NCCPA | |
| 101951 | Other | NC | NC LIC # |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1016582 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physicians Eldercare PA | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
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 and National Provider Directory roles.
-
- General Practice Physician
- Durham, NC
- NPI 1023083268
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1760462485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6911-100 SHANNON WILLOW RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28226",
"telephone_number": "704-529-4101",
"fax_number": "704-529-6655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6911-100 SHANNON WILLOW RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28226",
"telephone_number": "704-529-4101",
"fax_number": "704-529-6655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERRILL",
"first_name": "SUSAN",
"middle_name": "ELLEN",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-19",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "1016582",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8101095",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCCPA",
"identifier": "1016582",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC LIC #",
"identifier": "101951",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.