Active NPI
Susanne M Colligon, NP
- Family Nurse Practitioner
- Richmond, VA
National Provider Identifier
1760634885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 0024167970
- Practice address
- 5855 Bremo Rd
Suite 403
Richmond, VA 23226-1930 - Phone
- (804) 288-2673
- Fax
- (804) 285-5572
- NPI assigned
- Oct 21, 2008
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 0024167970 | VA | Primary |
Addresses
Primary practice location
5855 Bremo Rd
Suite 403
Richmond, VA 23226-1930
Mailing address
5855 Bremo Rd
Suite 403
Richmond, VA 23226-1930
Phone (804) 288-2673
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C06778 | Other | VA | GROUP PTAN |
| 1760634885 | Medicaid | VA |
Other names 1
- Susanne C Fessick
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024167970 | VA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bon Secours-St. Mary'S Hospital of Richmond, Inc. | Past | Accepting new patients |
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.
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- Richmond, VA
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433808000000",
"number": "1760634885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5855 BREMO RD",
"address_2": "SUITE 403",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232261930",
"telephone_number": "804-288-2673",
"fax_number": "804-285-5572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5855 BREMO RD",
"address_2": "SUITE 403",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232261930",
"telephone_number": "804-288-2673",
"fax_number": "804-285-5572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLIGON",
"first_name": "SUSANNE",
"middle_name": "M",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-21",
"last_updated": "2015-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "VA",
"license": "0024167970",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP PTAN",
"identifier": "C06778",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1760634885",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUSANNE",
"last_name": "FESSICK",
"middle_name": "C",
"credential": "NP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.