Active NPI
Susan Marie Koger, NP
- Adult Health Nurse Practitioner
- Baldwin, MI
National Provider Identifier
1841591476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 4704139637
- Practice address
- 1615 Michigan Ave
Baldwin, MI 49304-7984 - Phone
- (231) 745-4624
- Fax
- (231) 745-5031
- NPI assigned
- Nov 12, 2010
- Last updated
- Aug 4, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704139637 | MI | |
| Adult Health Nurse Practitioner | 363LA2200X | 4704139637 | MI | Primary |
Addresses
Primary practice location
1615 Michigan Ave
Baldwin, MI 49304-7984
Mailing address
4706 Cooper Ave
Royal Oak, MI 48073-1514
Phone (248) 310-1270
Other names 1
- Susan Marie Haven
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628035200000",
"number": "1841591476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4706 COOPER AVE",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480731514",
"telephone_number": "248-310-1270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1615 MICHIGAN AVE",
"city": "BALDWIN",
"state": "MI",
"postal_code": "493047984",
"telephone_number": "231-745-4624",
"fax_number": "231-745-5031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOGER",
"first_name": "SUSAN",
"middle_name": "MARIE",
"name_prefix": "Miss",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-11-12",
"last_updated": "2021-08-04",
"certification_date": "2021-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704139637",
"primary": false
},
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MI",
"license": "4704139637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "HAVEN",
"middle_name": "MARIE",
"credential": "HAVEN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Baldwin, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.