NPIMap

Individual provider Active NPI

Susan Lee Dasta, D.O.

  • Family Medicine Physician
  • Glendale, CA
National Provider Identifier
1851452635
Registry record updated Jul 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2002019232 Issued in MO
Practice address
1560 E Chevy Chase Dr
245
Glendale, CA 91206-4197
Phone
(818) 246-5900
NPI assigned
Dec 13, 2006
Last updated
Jul 1, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2002019232 MO Primary

Addresses

Primary practice location

1560 E Chevy Chase Dr
245
Glendale, CA 91206-4197

Mailing address

1560 E Chevy Chase Dr
245
Glendale, CA 91206-4197
Phone (818) 246-5900

Other identifiers 5

IdentifierTypeStateIssuer
1851452635MedicaidMO
31636039OtherBLUECROSS BLUESHIELD OF KANSAS CITY
208318808MedicaidMO
200587160AMedicaidKS
200587160BMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20160728001954 CA Practitioner - Family Practice 7416029475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2750 Sycamore Dr
Simi Valley, CA 93065-1500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.77 of 100Reported as apm
Quality
81.54
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2002019232MOMDFamily Medicine Physician
14537CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Physicians Network Family Medicine CurrentSince Aug 1, 2016 Accepting new patients
Adventist Health Physicians Network CurrentSince Aug 1, 2016 Accepting new patients
Dignity Health Past Accepting new patients
Glendale Adventist Medical Center Past Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients
Midwest Division - RMC, LLC Past Accepting new patients
Research Family Physicians LLC Family Medicine Past Accepting new patients
North Kansas City Hospital Past Accepting new patients
Neighborhood Family Care, Inc. Family Medicine Past Accepting new patients

Locations

1560 E Chevy Chase Dr
Ste 245
Glendale, CA 91206
Phone (818) 246-5900

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 9

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467331200000",
    "number": "1851452635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E CHEVY CHASE DR",
            "address_2": "245",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064197",
            "telephone_number": "818-246-5900",
            "fax_number": "816-332-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 E CHEVY CHASE DR",
            "address_2": "245",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064197",
            "telephone_number": "818-246-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DASTA",
        "first_name": "SUSAN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2016-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2002019232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851452635",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD OF KANSAS CITY",
            "identifier": "31636039",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208318808",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200587160A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200587160B",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.