Susan Holland Gibson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME0063597 Issued in FL

Practice address

10,000 Bay Pines Blvd
Dept of Medicine
Bay Pines, FL 33744

Phone

(727) 398-6661

Fax

(727) 319-1054

NPI assigned

Jul 5, 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

Medicare fee-for-service enrollment

Enrolled in FL

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

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770514341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19810 GULF BLVD",
            "address_2": "#4",
            "city": "INDIAN SHORES",
            "state": "FL",
            "postal_code": "337852314",
            "telephone_number": "727-593-3400",
            "fax_number": "727-593-2829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10,000 BAY PINES BLVD",
            "address_2": "DEPT OF MEDICINE",
            "city": "BAY PINES",
            "state": "FL",
            "postal_code": "33744",
            "telephone_number": "727-398-6661",
            "fax_number": "727-319-1054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "SUSAN",
        "middle_name": "HOLLAND",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0063597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Gautraux Sr., RRT
• Jacqueline Louise Geleta, MA, CCC-SLP
• Sara Gerges
• Jessica Gabriell Germano, LCSW
• Mary Lynn Getchell, RD
• Tiffanie Leeanne Glessner, LMSW
• Jessica Glover, DPT
• Christina Goddard, R.D.
• John Thomas Goodgame Jr., M.D.
• Rachel Elizabeth Goodman

• Internal Medicine Physician in Bay Pines, FL
• Providers in Bay Pines, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.