KENNY SUSANTO MD NPI 1255783270

NPI Information

  • NPI: 1255783270
  • Provider Name: KENNY SUSANTO, MD
  • Classification: Psychiatry & Neurology - 2084N0400X
  • Specialization: Neurology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2000 S WHEELING AVE STE 701
    TULSA, OK
    ZIP 74104
  • Phone: (918) 748-7810

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NPI Details

Kenny Susanto, MD is a neurology psychiatry neurology in Tulsa, OK with 14 years of experience. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. Kenny Susanto, MD NPI is 1255783270. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2000 S WHEELING AVE STE 701
TULSA, OK
ZIP 74104-647
Phone: (918) 748-7810

The NPI 1255783270 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • New patient office or other outpatient visit, 60-74 minutes (HCPCS:99205)
  • Established patient office or other outpatient visit, 40-54 minutes (HCPCS:99215)
  • Established patient office or other outpatient visit, 30-39 minutes (HCPCS:99214)
  • New patient office or other outpatient visit, 45-59 minutes (HCPCS:99204)
  • Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or (HCPCS:G2212)

The enumeration date for this NPI number is 7/2/2016 and was last updated on 6/27/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084N0400XPsychiatry & NeurologyNeurology1.065004CONNECTICUTNo
22084N0400XPsychiatry & NeurologyNeurology008863GEORGIANo
32084N0400XPsychiatry & NeurologyNeurology38794OKLAHOMAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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