Susan Lyasko Klugewicz, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD45116 Issued in TN

Practice address

1500 W Elk Ave
Elizabethton, TN 37643

Phone

(423) 543-2584

Fax

(423) 722-2060

NPI assigned

May 2, 2006

Last updated

Sep 12, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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

Pediatric Medicine

Education

University of Cincinnati College of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Care PLLCGroup PAC ID 1850448580, 40 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medical Care PLLC

  • Family Medicine Physician
  • Elizabethton, TN
  • NPI 1851537260
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1992763981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E MAIN ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376014877",
            "telephone_number": "423-929-2584",
            "fax_number": "423-722-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 W ELK AVE",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "37643",
            "telephone_number": "423-543-2584",
            "fax_number": "423-722-2060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 E Main St",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376014877",
            "country_code": "US",
            "telephone_number": "423-929-2584",
            "fax_number": "423-722-2060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLUGEWICZ",
        "first_name": "SUSAN",
        "middle_name": "LYASKO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-02",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD45116",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME78055",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1514567",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebekah N King
• Celesta V Kirk, FNP
• James Kirkpatrick III, MD
• Chelsea Lynn Kiser, RN
• Tammy L Kitchens, M.D.
• Ajay Philip Koleth
• Kansas Jessee Krabbe, FNP-C
• Benjamin Krug, MS, OTR/L
• Sudha Raj Kumar, NURSE PRACTITIONER
• L & L Drug Company Inc (Lingerfelt Pharmacy)

• Pediatrics Physician in Elizabethton, TN
• Providers in Elizabethton, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; 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.