Individual provider Active NPI

Susan Ngobi, FNP

  • Family Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1861945057
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209022005 Issued in IL
Practice address
2656 N Elston Ave
Chicago, IL 60647-2019
Phone
(866) 389-2727
Fax
(401) 216-3854
NPI assigned
Jul 25, 2016
Last updated
Oct 22, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 340786 NY
Family Nurse Practitioner 363LF0000X F340786-1 NY
Family Nurse Practitioner 363LF0000X 209022005 IL Primary

Addresses

Primary practice location

2656 N Elston Ave
Chicago, IL 60647-2019

Mailing address

2656 N Elston Ave
Chicago, IL 60647-2019
Phone (866) 389-2727

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20160914000377 NY Practitioner - Nurse Practitioner 9032405253 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
340786NYMDFamily Nurse Practitioner
F340786-1NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Aug 1, 2016 Accepting new patients
New York University CurrentSince Aug 1, 2016 Accepting new patients
Medical Group of New York, P.C. Family CurrentSince Mar 28, 2019 Accepting new patients

Locations

107 S Country Rd
Bellport, NY 11713
Phone (631) 286-2222

156 Henry St
Brooklyn, NY 11201
Phone (718) 237-5001

7960 Metropolitan Ave
Middle Village, NY 11379
Phone (718) 326-4910

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: sngobi95316@nyumc.direct-ci.com
  • Direct secure messaging: susan.ngobi.1@24265.direct.athenahealth.com
  • Direct secure messaging: susan.ngobi.1@24989.direct.athenahealth.com

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, 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": "1469404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1861945057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2656 N ELSTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472019",
            "telephone_number": "866-389-2727",
            "fax_number": "401-216-3854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2656 N ELSTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472019",
            "telephone_number": "866-389-2727",
            "fax_number": "401-216-3854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGOBI",
        "first_name": "SUSAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-25",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "340786",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F340786-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209022005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.