Individual provider Active NPI

Susan Rudman, EDD

  • Clinical Psychologist
  • Beverly, MA
National Provider Identifier
1992722714
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6593 Issued in MA
Practice address
800 Cummings Ctr
Suite 266T
Beverly, MA 01915-6175
Phone
(978) 921-1190
Fax
(978) 927-3724
NPI assigned
Jul 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6593 MA Primary

Addresses

Primary practice location

800 Cummings Ctr
Suite 266T
Beverly, MA 01915-6175

Mailing address

800 Cummings Ctr
Suite 266T
Beverly, MA 01915-6175
Phone (978) 921-1190

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040413000876 MA Practitioner - Clinical Psychologist 3870587728 Reassigns benefits to 1 organization
Practice locations: Salem, MA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

60 Washington St
Suite 202
Salem, MA 01970-3516
Phone (978) 741-7897

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6593MAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Behavioral Health Corporation CurrentSince Sep 1, 2010 Accepting new patients

Locations

800 Cummings Ctr
Ste 266T
Beverly, MA 01915

199 Rosewood Dr
Ste 250
Danvers, MA 01923
Phone (978) 867-7756

12 Methuen St
Ste 3
Lawrence, MA 01840
Phone (978) 683-3128

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992722714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CUMMINGS CTR",
            "address_2": "SUITE 266T",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156175",
            "telephone_number": "978-921-1190",
            "fax_number": "978-927-3724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 CUMMINGS CTR",
            "address_2": "SUITE 266T",
            "city": "BEVERLY",
            "state": "MA",
            "postal_code": "019156175",
            "telephone_number": "978-921-1190",
            "fax_number": "978-927-3724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDMAN",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "EDD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "6593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly, MA

Sources for this page

Verify at the official NPI Registry.