Active NPI
Susan Marie Edgerly, R.D., C.D.
- Registered Dietitian
- Spokane, WA
National Provider Identifier
1861563579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI00001556
- Practice address
- 800 W 5TH Ave
Spokane, WA 99210-0248 - Phone
- (509) 473-2272
- Fax
- (509) 473-4916
- NPI assigned
- Nov 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DI00001556 | WA | Primary |
Addresses
Primary practice location
800 W 5TH Ave
Spokane, WA 99210-0248
Mailing address
PO Box 842151
Dallas, TX 75284-2151
Phone (509) 458-5800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8496721 | Medicaid | WA |
Other names 1
- Susan Marie Holland
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI00001556 | WA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spokane Valley Washington Hospital Company LLC | Dietitian, Registered | Past | Accepting new patients |
| Empire Health Services | Past | Accepting new patients | |
| Spokane Washington Hospital Company LLC | Dietitian, Registered | 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.
-
- General Acute Care Hospital
- Spokane, WA
- NPI 1336194893
-
- Registered Dietitian
- Spokane Valley, WA
- NPI 1598905663
Dietitian, Registered
-
- Registered Dietitian
- Spokane, WA
- NPI 1053551127
Dietitian, Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251763200000",
"number": "1861563579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 842151",
"city": "DALLAS",
"state": "TX",
"postal_code": "752842151",
"telephone_number": "509-458-5800",
"fax_number": "509-473-4916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 W 5TH AVE",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992100248",
"telephone_number": "509-473-2272",
"fax_number": "509-473-4916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDGERLY",
"first_name": "SUSAN",
"middle_name": "MARIE",
"credential": "R.D., C.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2009-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI00001556",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8496721",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "HOLLAND",
"middle_name": "MARIE",
"credential": "R.D., C.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.