SUSAN J TATE (NPI# 1184611519) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184611519 |
| Entity Type | Individual |
| Full Name | SUSAN J TATE |
| Credential | MD |
| Practice Address |
4076 Neely Road Fort Wainwright AK 99703 |
| Mailing Address |
Po Box 80848 Fairbanks AK 99708-0848 |
| Practice Telephone | 9073615479 |
| Mailing Telephone | 8663218433 |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2018-05-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
4295 | AK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | MD0991 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457675563 | Susan R Tate | Physical Therapist | 3006 Mcneil Ave, Wichita Falls, TX 76309-4954 | 2010-03-18 |
| 1558610501 | Susan Tate | Counselor | 1322 W Main St, Antlers, OK 74523-2016 | 2012-09-06 |
| 1184705261 | Susan Ray Tate | Psychologist | 3350 La Jolla Village Dr # 116b, San Diego, CA 92161-0002 | 2006-10-17 |
| 1053320259 | Susan Tate | Physician Assistant | 3401 Springhill Dr, Suite 460, North Little Rock, AR 72117-2924 | 2006-08-05 |
| 1811913585 | Susan S.b. Tate | Obstetrics & Gynecology | 2934 Breckenridge Ln Ste 2, Louisville, KY 40220-3903 | 2006-07-14 |
| Street Address |
4076 NEELY ROAD |
| City | FORT WAINWRIGHT |
| State | AK |
| Zip Code | 99703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609379726 | Michael Bolan | Pharmacist | 4076 Neely Road, Fort Wainwright, AK 99709 | 2018-03-15 |
| 1588179535 | John David Boswell | Physician Assistant | 4076 Neely Road, Fort Wainwright, AK 99703 | 2017-12-12 |
| 1235677717 | Ashley Lynn Bain | Registered Nurse | 4076 Neely Road, Fort Wainwright, AK 99703 | 2017-02-06 |
| 1306380928 | John Merrill Manning | Psychologist | 4076 Neely Road, Attn: Dept of Behavioral Health, Fort Wainwright, AK 99703 | 2016-12-16 |
| 1891143129 | Brian Trinh | Pharmacist | 4076 Neely Road, Fort Wainwright, AK 99703 | 2016-05-26 |
| 1871951905 | Donia Inez Blauvelt | Pediatrics | 4076 Neely Road, Fort Wainwright, AK 99703-7400 | 2016-02-03 |
| 1952790974 | Meagen Sassman | Dietitian, Registered | 4076 Neely Road, Fort Wainwright, AK 99703-7440 | 2015-01-14 |
| 1568870418 | Ryan Michael Laplace | General Practice | 4076 Neely Road, Fort Wainwright, AK 99703 | 2014-07-23 |
| 1912317728 | Debora Renee Wells-mcmanus | Social Worker | 4076 Neely Road, Fort Wainwright, AK 99703 | 2014-05-01 |
| 1770877417 | Christina Marie Hylden | Orthopaedic Surgery | 4076 Neely Road, Fort Wainwright, AK 99703-7440 | 2011-05-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144866435 | Rebecca P Conner | Registered Nurse | Bach, 1060 Gafney Rd, Ft Wainwright, AK 99703 | 2019-11-21 |
| 1881242030 | Stephanie Morse | Counselor | Bldg 3406 Alder Ave, Ft. Wainwright, AK 99703 | 2019-08-30 |
| 1801376702 | Matthew Gerard Somma | Physician Assistant | 1-25 Attack Reconnaissance Bn, Fort Wainwright, AK 99703 | 2018-08-20 |
| 1003268657 | Brandy Tristan | Dental Hygienist | Bldg 3406, Troop Dental Clinic, Ft. Wainwright, AK 99703 | 2016-07-07 |
| 1174998918 | Jeffrey Grace | Physician Assistant | Bassett Army Medical Center (kamish Clinic), 1060 Gaffney Rd, Ft Wainwright, AK 99703 | 2015-12-04 |
| 1073999215 | Melanie Anne Whalen | Dentist | 4055 Tamarak Dr, Ft Wainwright, AK 99703 | 2015-08-10 |
| 1790183176 | Sally Jane Rall | Counselor | 3406 Adler Ave, Fairbanks, AK 99703 | 2014-12-16 |
| 1083029193 | Francesann Hill | General Practice | 3214 East Santiago Avenue, Apo, AP 99703 | 2014-06-26 |
| 1669883146 | Amber Benton | Psychiatry & Neurology | 4005-4007 602nd St, Fort Wainwright, AK 99703 | 2014-05-18 |
| 1952720898 | Allison Hubert | Occupational Therapist | 3410 Rhineland Ave, Rm 108, Fort Wainwright, AK 99703 | 2014-04-08 |
| Find all providers in zip 99703 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922399666 | Emily W Piercefield | Emergency Medicine | 709 W 9th St Ste 627, Juneau, AK 99801-1807 | 2011-04-28 |
| 1376782458 | Seamus M Siddall | Emergency Medicine | 200 A Street, Siddall Medical Services At Clear Afs, Clear Afs, AK 99704 | 2009-02-12 |
| 1679566269 | South Peninsula Hospital, Inc. | Emergency Medicine | 4300 Bartlett Street, Homer, AK 99603-7005 | 2005-08-29 |
| 1639539596 | Nathaniel Guy Jimenez | Emergency Medicine | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2016-03-03 |
| 1902932213 | Thomas P Lyngholm | Emergency Medicine | 1060 Gaffney Rd # 7440, Usa Meddac-ak, Mcuc-mmd-credentials, Ft Wainwright, AK 99703 | 2007-02-23 |
| 1710095914 | Carey Brent Gear | Emergency Medicine | 880 E End Rd, Homer, AK 99603-7201 | 2006-08-28 |
| 1679590327 | Craig Doser | Emergency Medicine | 250 Hospital Pl, Soldotna, AK 99669-7559 | 2006-07-17 |
| 1750307294 | Marion Constance Mcdevitt | Emergency Medicine | 1650 Cowles St, Fairbanks, AK 99701-5925 | 2006-07-15 |
| 1851366207 | Jim F Walery | Emergency Medicine | 1201 E 36th Ave, Anchorage, AK 99508-4372 | 2006-02-21 |
| 1417944687 | Daniel Safranek | Emergency Medicine | 3200 Providence Dr, Anchorage, AK 99508-4661 | 2005-10-04 |
| Find all providers with the same taxonomy | ||||
| City | FORT WAINWRIGHT |
| Zip Code | 99703 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.