Individual provider Active NPI

Susan Shaw Reines, MD

  • Pediatrics Physician
  • Lithonia, GA
National Provider Identifier
1770547994
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
032809 Issued in GA
Practice address
8011 Mall Parkway
Kaiser Permanente Stonecrest Medical Center
Lithonia, GA 30038
Phone
(678) 323-7510
Fax
(678) 323-7522
NPI assigned
Apr 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 032809 GA Primary
Specialist 174400000X 32809 GA

Addresses

Primary practice location

8011 Mall Parkway
Kaiser Permanente Stonecrest Medical Center
Lithonia, GA 30038

Mailing address

3495 Piedmont Road NE
Nine Piedmont Center
Atlanta, GA 30305
Phone (404) 364-7000

Other names 1

  • Susan Shaw Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
32809GAMDSpecialist
032809GAMDPediatrics Physician

Interoperability endpoints

  • Direct secure messaging: sreines1414@choa.gadirect.net

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1770547994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3495 PIEDMONT ROAD NE",
            "address_2": "NINE PIEDMONT CENTER",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30305",
            "telephone_number": "404-364-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8011 MALL PARKWAY",
            "address_2": "KAISER PERMANENTE STONECREST MEDICAL CENTER",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "30038",
            "telephone_number": "678-323-7510",
            "fax_number": "678-323-7522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REINES",
        "first_name": "SUSAN",
        "middle_name": "SHAW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-14",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "032809",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "32809",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5440 Hillandale Dr",
            "city": "Lithonia",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300584865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "SHAW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lithonia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.