Susan Grosse-macemon, | |
153 Cesar Chavez St, W. St. Paul, MN 55107-2226 | |
(651) 222-1816 | |
(651) 222-2226 |
Full Name | Susan Grosse-macemon |
---|---|
Gender | Female |
Speciality | Nurse Practitioner - Family |
Location | 153 Cesar Chavez St, W. St. Paul, Minnesota |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1922060169 | NPI | - | NPPES |
153842000 | Medicaid | MN | |
923911025971 | Other | MN | PREFERRED ONE |
0102292 | Other | MN | MEDICA |
108562 | Other | MN | UCARE |
53M29GR | Other | MN | BCBS |
HP26519 | Other | MN | HEALTH PARTNERS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LF0000X | Nurse Practitioner - Family | 1451 (Minnesota) | Primary |
Entity Name | Fairview Health Services |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1013994359 PECOS PAC ID: 1951213057 Enrollment ID: O20031105000461 |
Entity Name | Fairview Clinics |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1346432218 PECOS PAC ID: 7113830142 Enrollment ID: O20031106000516 |
Entity Name | Healtheast Medical Research Institute |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1639125503 PECOS PAC ID: 3971407636 Enrollment ID: O20031124000507 |
Entity Name | Healtheast St Joseph's Hospital |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1134186273 PECOS PAC ID: 2365348869 Enrollment ID: O20031208000245 |
Mailing Address | Practice Location Address |
---|---|
Susan Grosse-macemon, 153 Cesar Chavez St, W. St. Paul, MN 55107-2226 Ph: (651) 222-1816 | Susan Grosse-macemon, 153 Cesar Chavez St, W. St. Paul, MN 55107-2226 Ph: (651) 222-1816 |
Ms. Christine Anita Chitambar, CNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 153 Cesar Chavez St, W. St. Paul, MN 55107 Phone: 651-222-1816 Fax: 651-222-1305 |