| 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 |
| 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 |