Active NPI
Suzanne M Bailey, M.D
- Pediatrics Physician
- Salt Lake City, UT
National Provider Identifier
1942442355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD161218
- Practice address
- 100 Mario Capecchi Dr
Salt Lake City, UT 84113-1103 - Phone
- (503) 569-1008
- NPI assigned
- Mar 31, 2009
- Last updated
- Sep 19, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Pediatrics Physician | 208000000X | MD161218 | OR | Primary |
Addresses
Primary practice location
100 Mario Capecchi Dr
Salt Lake City, UT 84113-1103
Mailing address
2478 13TH St SE
Salem, OR 97302-2546
Phone (503) 362-2481
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500655210 | Medicaid | OR |
Other names 1
- Suzanne M Sides
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131001000494 | OR | Practitioner - Pediatric Medicine | 0042455016 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD161218 | OR | MD | Pediatrics Physician |
Interoperability endpoints
- suzannebailey@direct.wvp.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568851200000",
"number": "1942442355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2478 13TH ST SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973022546",
"telephone_number": "503-362-2481",
"fax_number": "503-375-8700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MARIO CAPECCHI DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841131103",
"telephone_number": "503-569-1008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAILEY",
"first_name": "SUZANNE",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-03-31",
"last_updated": "2019-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OR",
"license": "MD161218",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500655210",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUZANNE",
"last_name": "SIDES",
"middle_name": "M",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.