Susannah Nicholson Dintzis, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209-002547 Issued in IL

Practice address

2321 N Wisconsin Ave
Peoria, IL 61603-5613

Phone

(309) 680-7600

Fax

(309) 681-4681

NPI assigned

Jun 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Heartland Community Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Peoria, IL
  • NPI 1336193861
  Medicare reassignment NPD
• Methodist Medical Center of Illinois

  • Family Medicine Physician
  • Peoria, IL
  • NPI 1184670663
  Medicare reassignment NPD
• Heartland Community Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Peoria, IL
  • NPI 1568883718
  NPD
• Heartland Community Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Peoria, IL
  • NPI 1922561000
  NPD
• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755

  Family

  NPD
• Heartland Community Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Peoria, IL
  • NPI 1467658443
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550448000000",
    "number": "1902848153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616043221",
            "telephone_number": "309-680-7669",
            "fax_number": "309-681-8443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 N WISCONSIN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616035613",
            "telephone_number": "309-680-7600",
            "fax_number": "309-681-4681"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 W Romeo B Garrett Ave",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616052207",
            "country_code": "US",
            "telephone_number": "309-676-9825",
            "fax_number": "309-672-1518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DINTZIS",
        "first_name": "SUSANNAH",
        "middle_name": "NICHOLSON",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2019-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "041283996",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209-002547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PPO",
            "identifier": "7215059",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bonita G. Dietrich
• Cole J Dill, CRNA
• Dennis Wayne Dillard, C.PED., CTO
• Molly Dimler, PT, DPT, WCS
• Dzung Hong Dinh, MD
• Keith Dirl, LCPC
• Debra Fay Disney, LCPC
• Senuri Upeksha Dissanayake, MD
• Bhakti Anant Dixit
• Gerald Dixon

• Family Nurse Practitioner in Peoria, IL
• Providers in Peoria, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.