NPIMap

Individual provider Active NPI

Susan M Rabenber, NP, CNP

  • Family Nurse Practitioner
  • Montgomery, MN
National Provider Identifier
1922118967
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R130725-2 Issued in MN
Practice address
202 1St St S
Montgomery, MN 56069-1602
Phone
(507) 364-5600
Fax
(507) 364-5686
NPI assigned
Aug 30, 2006
Last updated
Oct 27, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R130725-2 MN Primary

Addresses

Primary practice location

202 1St St S
Montgomery, MN 56069-1602

Mailing address

301 Main St E
New Prague, MN 56071-1803
Phone (952) 758-1050

Other identifiers 1

IdentifierTypeStateIssuer
257504300MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address srabenberg91854@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070717000217 MN Practitioner - Nurse Practitioner 2961502182 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mayo Clinic Health System-Southwest Minnesota RegionGroup PAC ID 4688585771, shared by 6 NPIs, 658 clinicians

Practice addresses (Care Compare)

1025 Marsh St
Mankato, MN 56001-4752
Phone (507) 625-4031

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R130725-2MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Jan 1, 2015 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Jan 1, 2015 Accepting new patients

Locations

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

200 Alton Ave SE
New Prague, MN 56071
Phone (952) 758-3132

301 2nd St NE
New Prague, MN 56071
Phone (952) 758-4431

Interoperability endpoints

  • Direct secure messaging: srabenberg91854@ehrdirect.mayoclinicmsg.org

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1922118967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MAIN ST E",
            "city": "NEW PRAGUE",
            "state": "MN",
            "postal_code": "560711803",
            "telephone_number": "952-758-1050",
            "fax_number": "952-758-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 1ST ST S",
            "city": "MONTGOMERY",
            "state": "MN",
            "postal_code": "560691602",
            "telephone_number": "507-364-5600",
            "fax_number": "507-364-5686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RABENBER",
        "first_name": "SUSAN",
        "middle_name": "M",
        "credential": "NP, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R130725-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257504300",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "srabenberg91854@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "202 1st St S",
            "city": "Montgomery",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560691602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Montgomery, MN

Sources for this page

Verify at the official NPI Registry.