NPIMap

Individual provider Active NPI

Susan Elizabeth Caverly, PHD,ARNP,MA,BC

  • Psychiatric/Mental Health Registered Nurse
  • Chelan, WA
National Provider Identifier
1851402622
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X
License
AP30000933 Issued in WA
Practice address
144 E Johnson Ave Unit 1325
Chelan, WA 98816-9484
Phone
(206) 369-3068
NPI assigned
Aug 31, 2006
Last updated
Oct 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered Nurse 163WP0808X AP30000933 WA Primary

Addresses

Primary practice location

144 E Johnson Ave Unit 1325
Chelan, WA 98816-9484

Mailing address

PO Box 1325
Chelan, WA 98816-1325
Phone (206) 369-3068

Other identifiers 1

IdentifierTypeStateIssuer
9605916MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20050823000738 WA Practitioner - Nurse Practitioner 0345271003 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Columbia Valley Community HealthGroup PAC ID 7113813874, 64 clinicians

Practice addresses (Care Compare)

105 S Apple Blossom Dr
Chelan, WA 98816-8810
Phone (509) 682-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts, Nurse Practitioner, Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia Valley Community Health CurrentSince Apr 16, 2023 Accepting new patients
Columbia Valley Community Health CurrentSince Apr 16, 2023 Accepting new patients
Therapeutic Health Services PastSince May 7, 2023 Accepting new patients
Kelly Knickerbocker Arnp PLLC PastSince Aug 1, 2020 Accepting new patients

Locations

105 S Apple Blossom Dr
Chelan, WA 98816
Phone (509) 682-6000

600 Orondo Ave
Ste 1
Wenatchee, WA 98801
Phone (509) 664-4575

Interoperability endpoints

  • Direct secure messaging: susan.caverly.1@10575.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lincoln Elementary School ClinicWenatchee, WA, CCN 941053 Federally qualified health center W-2 Managing Employee Mar 21, 2023
New PathWenatchee, WA, CCN 941054 Federally qualified health center W-2 Managing Employee Mar 21, 2023
Columbia Valley Community HealthEast Wenatchee, WA, CCN 501030 Federally qualified health center W-2 Managing Employee Mar 21, 2023
980 Psychiatric MedicalEast Wenatchee, WA, CCN 501066 Federally qualified health center W-2 Managing Employee Mar 21, 2023

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1851402622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1325",
            "city": "CHELAN",
            "state": "WA",
            "postal_code": "988161325",
            "telephone_number": "206-369-3068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 E JOHNSON AVE UNIT 1325",
            "city": "CHELAN",
            "state": "WA",
            "postal_code": "988169484",
            "telephone_number": "206-369-3068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVERLY",
        "first_name": "SUSAN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PHD,ARNP,MA,BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP30000933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9605916",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chelan, WA

Sources for this page

Verify at the official NPI Registry.