NPIMap

Individual provider Active NPI

Susan S.B. Tate, M.D.

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Louisville, KY
National Provider Identifier
1811913585
Registry record updated Jun 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
License
39021 Issued in KY
Practice address
2934 Breckenridge LN Ste 2
Louisville, KY 40220-3903
Phone
(502) 454-7871
Fax
(502) 454-7872
NPI assigned
Jul 14, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 23, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X 39021 KY Primary

Addresses

Primary practice location

2934 Breckenridge LN Ste 2
Louisville, KY 40220-3903

Mailing address

2934 Breckenridge LN Ste 2
Louisville, KY 40220-3903
Phone (502) 454-7871

Other practice location 1

9115 Leesgate Rd Ste B
Louisville, KY 40222-6017
Phone (502) 454-7871

Other identifiers 7

IdentifierTypeStateIssuer
000000337344OtherKSANTHEM
50004926OtherKYPASSPORT PCP
200502730MedicaidIN
50015262OtherKYPASSPORT SPECIALITY
50004854OtherKYPASSPORT SPECIALITY
64084148MedicaidKY
000000338030OtherKYANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040823001322 KY Practitioner - Obstetrics/Gynecology 7618941949 Receives reassigned benefits from 1 practitioner
Practice locations: Louisville, KY

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Medical University of South Carolina College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2934 Breckenridge LN
Suite 2
Louisville, KY 40220-3903
Phone (502) 454-7871

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
The University Gynecological & Obstetrical Foundation, Inc. Past Accepting new patients
Susan B Tate MD PA Urogynecology and Reconstructive Pelvic Surgery PastSince Mar 25, 2012 Accepting new patients

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782172800000",
    "number": "1811913585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2934 BRECKENRIDGE LN STE 2",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402203903",
            "telephone_number": "502-454-7871",
            "fax_number": "502-454-7872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2934 BRECKENRIDGE LN STE 2",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402203903",
            "telephone_number": "502-454-7871",
            "fax_number": "502-454-7872"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9115 Leesgate Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402226017",
            "country_code": "US",
            "telephone_number": "502-454-7871",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TATE",
        "first_name": "SUSAN",
        "middle_name": "S.B.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "KY",
            "license": "39021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000337344",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT PCP",
            "identifier": "50004926",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200502730",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT SPECIALITY",
            "identifier": "50015262",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT SPECIALITY",
            "identifier": "50004854",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64084148",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000338030",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.