Active NPI
Susan Ann Raque
- Military Health Care Provider
- Louisville, KY
National Provider Identifier
1871248179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Military Health Care Provider
- License
- 1082389
- Practice address
- 1700 Cargo CT
Louisville, KY 40299-1938 - Phone
- (800) 805-6989
- NPI assigned
- Feb 15, 2022
- 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 |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | 1082389 | KY | Primary |
Addresses
Primary practice location
1700 Cargo CT
Louisville, KY 40299-1938
Mailing address
1700 Cargo CT
Louisville, KY 40299-1938
Phone (800) 805-6989
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1082389 | KY | MD | Military Health Care Provider |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644883200000",
"number": "1871248179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 CARGO CT",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402991938",
"telephone_number": "800-805-6989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 CARGO CT",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402991938",
"telephone_number": "800-805-6989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAQUE",
"first_name": "SUSAN",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-15",
"last_updated": "2022-02-15",
"certification_date": "2022-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "KY",
"license": "1082389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.