Susmita Hazarika

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD479425 Issued in PA

Practice address

1420 Walnut St Ste 1012
Philadelphia, PA 19102-4010

Phone

(855) 940-4867

NPI assigned

Feb 3, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, PA2 enrollments

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 2

Specialty

Psychiatry

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: greenbrooktmspa.susmitahazarika@158157.advancedmd-direct.com

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.

• Behavioral Solutions Medical, PC

  • Psychiatry Physician
  • Bryn Mawr, PA
  • NPI 1790257335

  PA, Psychiatry

  Medicare reassignment NPD
• Nurowav TMS PC

  • Psychiatry Physician
  • Langhorne, PA
  • NPI 1457054975

  PA, Psychiatry

  Medicare reassignment NPD
• MCCD FL Psychiatry Services PA

  • Psychiatry Physician
  • Jacksonville, FL
  • NPI 1659003457

  PA, Psychiatry

  Medicare reassignment NPD
• MCCD Psychiatry Services PLLC

  • Psychiatry Physician
  • New York, NY
  • NPI 1033750823

  NY, PA, Psychiatry

  Medicare reassignment NPD

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

{
    "created_epoch": "1486080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1982142550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 E 63RD ST APT 33L",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100657929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 WALNUT ST STE 1012",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191024010",
            "telephone_number": "855-940-4867"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5092 Nottingham Place Ln",
            "address_2": "APT 202",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271064690",
            "country_code": "US",
            "telephone_number": "336-716-4551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "504 E 63rd St Apt 33L",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100657929",
            "country_code": "US",
            "telephone_number": "917-783-3078",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAZARIKA",
        "first_name": "SUSMITA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-03",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "224287",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "317453",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD479425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Hayward, MD
• Kathleen Hayward, MD
• Melissa Haywarrd, LMT
• Daniela Hazan
• Emma Hazanov, MSW, M.ED
• Hazel Physical Therapy and Wellness
• Lisa Hazel
• Benjamin Hindle Hazen, LPC
• Jessica Benesch Hazen, D.O.
• Andros Frailey Hazipetros

• All providers in Philadelphia, PA
• Psychiatry Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; 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.