Susan Marie Wassenhove, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601001412 Issued in MI

Practice address

812 W 4TH St
Mishawaka, IN 46544-1738

Phone

(574) 255-1604

NPI assigned

Jun 30, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Ascension Borgess Lee Hospital

  • Rural Health Clinic/Center
  • Dowagiac, MI
  • NPI 1194717504
  Medicare reassignment
• Ascension Borgess Lee Hospital

  • Hospitalist Physician
  • Dowagiac, MI
  • NPI 1467315499
  NPD

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298419200000",
    "number": "1861420341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 W 4TH STREET",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "46544",
            "telephone_number": "574-255-1604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 W 4TH ST",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441738",
            "telephone_number": "574-255-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSENHOVE",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2011-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "1722",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601001412",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2692-23,",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4398",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles McDonald Ware Jr., M.D.
• Jill N. Warfield-Ziegert, O.D.
• Jan Earl Warner, PHD HSPP
• Shea Lee Warner
• Janelle Warrell
• Kathye J Waters, LMHC
• Tosha E Watkins, MNT
• Alan H Wax, PHD HSPP
• Chana Wax, CCC-SLP
• Rozi P Wax, LMHC

• Physician Assistant in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; 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.

Verify at the official NPI Registry.