Individual provider Active NPI

Susan H Lindstrom, RN,CFNP,CPNP

  • Family Nurse Practitioner
  • Charleston, SC
National Provider Identifier
1861435224
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2180 Issued in SC
Practice address
1483 Tobias Gadson Blvd
Suite 102
Charleston, SC 29407-8702
Phone
(843) 766-6229
Fax
(843) 766-2315
NPI assigned
Jun 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2180 SC Primary
Pediatric Nurse Practitioner 363LP0200X 2180 SC

Addresses

Primary practice location

1483 Tobias Gadson Blvd
Suite 102
Charleston, SC 29407-8702

Mailing address

1483 Tobias Gadson Blvd
Suite 102
Charleston, SC 29407-8702
Phone (843) 766-6229

Other identifiers 1

IdentifierTypeStateIssuer
197049MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
2180SCMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Wvva Health Care Alliance, PC Past Accepting new patients
Healthy4Life Integrated Medicine, Inc PastSince May 31, 2009 Accepting new patients
Kathleen Grabowski Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195516800000",
    "number": "1861435224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1483 TOBIAS GADSON BLVD",
            "address_2": "SUITE 102",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294078702",
            "telephone_number": "843-766-6229",
            "fax_number": "843-766-2315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1483 TOBIAS GADSON BLVD",
            "address_2": "SUITE 102",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294078702",
            "telephone_number": "843-766-6229",
            "fax_number": "843-766-2315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LINDSTROM",
        "first_name": "SUSAN",
        "middle_name": "H",
        "credential": "RN,CFNP,CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2007-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "2180",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "SC",
            "license": "2180",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197049",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.