NPIMap

Individual provider Active NPI

Susan L Raben-Taylor, M.D.

  • Family Medicine Physician
  • Fayetteville, AR
National Provider Identifier
1780613489
Registry record updated Mar 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
N-7882 Issued in AR
Practice address
525 N Garland Ave
Fayetteville, AR 72701-3110
Phone
(479) 582-1755
NPI assigned
Jul 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X N-7882 AR
Pain Medicine Physician 208VP0000X N-7882 AR
Family Medicine Physician 207Q00000X N-7882 AR Primary

Addresses

Primary practice location

525 N Garland Ave
Fayetteville, AR 72701-3110

Mailing address

525 N Garland Ave
Fayetteville, AR 72701-3110
Phone (870) 424-5079

Other identifiers 1

IdentifierTypeStateIssuer
12990OtherARQUALCHOICE INSURANCE ID#

Other names 1

  • Dr. Susan L. Raben Former name

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
N-7882ARMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arkansas MRI Services LLC Past Accepting new patients
Arkansas MRI Services, LLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553040000000",
    "number": "1780613489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N GARLAND AVE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727013110",
            "telephone_number": "870-424-5079",
            "fax_number": "870-424-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N GARLAND AVE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727013110",
            "telephone_number": "479-582-1755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RABEN-TAYLOR",
        "first_name": "SUSAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2019-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "AR",
            "license": "N-7882",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "AR",
            "license": "N-7882",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "N-7882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE INSURANCE ID#",
            "identifier": "12990",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "RABEN",
            "middle_name": "L.",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2019; 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.