Active NPI
Susan C Skaparas, NP
- Nurse Practitioner
- Brockton, MA
National Provider Identifier
1992761027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 110835
- Practice address
- 110 Liberty St
Brockton, MA 02301-5521 - Phone
- (508) 894-0400
- Fax
- (508) 894-0617
- NPI assigned
- Apr 26, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 110835 | MA | Primary |
| Family Nurse Practitioner | 363LF0000X | 110835 | MA |
Addresses
Primary practice location
110 Liberty St
Brockton, MA 02301-5521
Mailing address
110 Liberty St
Brockton, MA 02301-5521
Phone (508) 894-0400
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP0465 | Other | MA | BLUE CROSS |
| 39430 | Other | MA | HARVARD PILGRIM |
| 0327701 | Medicaid | MA |
Other names 1
- Susan C Divver
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110835 | MA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bridgewater Goddard Park Medical Associates, Inc. | Past | Accepting new patients |
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.
-
- Multi-Specialty Clinic/Center
- Brockton, MA
- NPI 1417932591
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307923200000",
"number": "1992761027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 LIBERTY ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023015521",
"telephone_number": "508-894-0400",
"fax_number": "508-894-0617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 LIBERTY ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023015521",
"telephone_number": "508-894-0400",
"fax_number": "508-894-0617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKAPARAS",
"first_name": "SUSAN",
"middle_name": "C",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-26",
"last_updated": "2011-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MA",
"license": "110835",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MA",
"license": "110835",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "NP0465",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "39430",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0327701",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "DIVVER",
"middle_name": "C",
"credential": "NP",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.