Active NPI
Susan Passalaqua, M.D.
- Diagnostic Radiology Physician
- Gilbert, AZ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 32391
- Practice address
- 2946 E Banner Gateway Dr.
Gilbert, AZ 85234 - Phone
- (480) 256-6444
- Fax
- (480) 256-4683
- NPI assigned
- Oct 21, 2005
- 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 32391 | AZ | Primary |
Addresses
Primary practice location
2946 E Banner Gateway Dr.
Gilbert, AZ 85234
Mailing address
2940 E Banner Gateway Dr. Ste 450
Gilbert, AZ 85234
Phone (480) 425-5063
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 843880 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ, SD, MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040701001142 | AZ | Practitioner - Diagnostic Radiology | 3375520919 | Reassigns benefits to 1 organization |
| I20230113002420 | SD | Practitioner - Diagnostic Radiology | 3375520919 | Reassigns benefits to 6 organizations |
| I20260112001910 | MN | Practitioner - Diagnostic Radiology | 3375520919 | Reassigns benefits to 4 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- Medical College of Ohio, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Glacial Ridge Hospital District
Practice addresses (Care Compare)
10 4TH Ave SE
Glenwood, MN 56334-1820
Phone (320) 634-4521
1325 S Cliff Ave
Sioux Falls, SD 57105-1007
201 W 69TH St
Sioux Falls, SD 57108-2403
Phone (605) 336-0635
20159 N Scottsdale Rd
Suite 100
Scottsdale, AZ 85255-6808
Phone (623) 265-7215
323 SW 10TH St
Madison, SD 57042-3200
Phone (605) 256-6551
525 N Foster St
Mitchell, SD 57301-2966
Phone (605) 995-2234
649 /2 State St NW
Evansville, MN 56326-8124
Phone (218) 948-2040
712 S Cascade St
Fergus Falls, MN 56537-2913
Phone (218) 736-8000
901 E Virgil Ave
Milbank, SD 57252-2124
Phone (605) 432-4538
910 E 20TH St
Sioux Falls, SD 57105-1012
Phone (605) 334-6730
Hospital & facility affiliations
- Avera McKennan Hospital & University Health Center
- City of Hope Cancer Center Phoenix
- Avera Heart Hospital of South Dakota
- Avera Marshall Regional Medical Ctr
- Regional Health Services of Howard County
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera Queen of Peace | Current | Accepting new patients | |
| Avera McKennan | Current | Accepting new patients | |
| Lake Region Healthcare Corporation | Current | Accepting new patients | |
| Avera Queen of Peace | Current | Accepting new patients | |
| Avera Queen of Peace | Current | Accepting new patients | |
| Urology Specialists Chartered | Current | Accepting new patients | |
| Madison Community Hospital | Current | Accepting new patients | |
| Avera Marshall | Current | Accepting new patients | |
| Lake Region Healthcare Corporation | Current | Accepting new patients | |
| Avera McKennan | Current | Accepting new patients | |
| Madison Community Hospital | Current | Accepting new patients | |
| Avera McKennan | Diagnostic Radiology | Current | Accepting new patients |
| Avera Marshall | Current | Accepting new patients | |
| Banner Imaging Associates PLC | Diagnostic Radiology | Past | Accepting new patients |
| Scottsdale Medical Imaging, LTD | Diagnostic Radiology | Past | Accepting new patients |
| Medical Doctors Imaging Inc a Medical Group | Diagnostic Radiology | Past | Accepting new patients |
| City of Hope Medical Group of Arizona LLC | Diagnostic Radiology | Past | Accepting new patients |
| Avera Tyler | Past | Accepting new patients | |
| Avera Queen of Peace | Past | Accepting new patients | |
| Southwest Diagnostic Imaging LLC | Diagnostic Radiology | Past | Accepting new patients |
| Regional Radiological Associates, Inc. a Medical Group | Diagnostic Radiology | Past | Accepting new patients |
| Granite Falls Municipal Hospital and Manor | Past | Accepting new patients |
Locations
1411 Highway 79 E
Elbow Lake, MN 56531
Phone (218) 685-7300
649 State St NW
Evansville, MN 56326
Phone (218) 948-2040
712 S Cascade St
Fergus Falls, MN 56537
300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631
323 SW 10th St
Madison, SD 57042
Phone (605) 256-6551
525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000
1325 S Cliff Ave
Sioux Falls, SD 57105
Phone (605) 322-5000
201 W 69th St
Sioux Falls, SD 57108
Phone (605) 336-0635
910 E 20th St
Sioux Falls, SD 57105
Phone (602) 338-7098
Interoperability endpoints
- susan.passalaqua.p1@direct.urologyspecialists.nextgenshare.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Organizations & group practices 24
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Sioux Falls, SD
- NPI 1699009944
SD
-
- Medical Oncology Physician
- Goodyear, AZ
- NPI 1609026806
AZ, Diagnostic Radiology
-
- Optometrist
- Marshall, MN
- NPI 1487422465
-
- Plastic and Reconstructive Surgery Physician
- Sioux Falls, SD
- NPI 1568829968
Hospital & facility affiliations 29
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Goodyear, AZ
- NPI 1508029422
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421798400000",
"number": "1891784880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2940 E BANNER GATEWAY DR. STE 450",
"city": "GILBERT",
"state": "AZ",
"postal_code": "85234",
"telephone_number": "480-425-5063",
"fax_number": "480-425-5010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2946 E BANNER GATEWAY DR.",
"city": "GILBERT",
"state": "AZ",
"postal_code": "85234",
"telephone_number": "480-256-6444",
"fax_number": "480-256-4683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PASSALAQUA",
"first_name": "SUSAN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-21",
"last_updated": "2015-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "AZ",
"license": "32391",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "843880",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.