Kenneth Roger Susman, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G679520 Issued in CA

Practice address

510 Cypress St
Suite B
Fort Bragg, CA 95437-5411

Phone

(707) 961-1972

Fax

(707) 961-1978

NPI assigned

Jan 9, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of California, Davis School of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Mendocino Coast Hospital, Fort Bragg, CA, CCN 051325
• Adventist Health Ukiah Valley Hospital, Ukiah, CA, CCN 050301

Merit-based Incentive Payment System (MIPS)

Final score

80.98 of 100Reported as group

Quality

73.31

Promoting interoperability

92

Improvement activities

40

Cost

62

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

• Adventist Health Mendocino Coast

  dba Mendocino Coast District Hospital

  • Critical Access Hospital
  • Fort Bragg, CA
  • NPI 1538113725
  Care Compare affiliation
• Ukiah Adventist Hospital

  dba Adventist Health Ukiah Valley

  • General Acute Care Hospital
  • Ukiah, CA
  • NPI 1235120676
  Care Compare affiliation

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962551119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 CYPRESS ST",
            "address_2": "SUITE B",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375411",
            "telephone_number": "707-961-1972",
            "fax_number": "707-961-1978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 CYPRESS ST",
            "address_2": "SUITE B",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375411",
            "telephone_number": "707-961-1972",
            "fax_number": "707-961-1978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSMAN",
        "first_name": "KENNETH",
        "middle_name": "ROGER",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G679520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Todd Stein, LCSW
• Stephen Pinsk, M.D., Inc. (Pathology Services)
• Pamela Joy Steward, MS, LMFT
• Natalie Maria Stewart, RPH
• Anthony Suarez Morales
• James William Swallow, MD
• Tapestry Family Services
• Scott Matthew Taubold, PH.D.
• Michele Marie Tellier, FNP
• Marleen Laura Tempelaere

• Specialist in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.