KENNY SUSANTO MD
NPI 1255783270
Psychiatry & Neurology - Neurology in Tulsa, OK

Active since July 02, 2016PECOS EnrolledAccepts Medicare Assignment
91.24/100
CMS Quality Rating
2000 S WHEELING AVE STE 701, TULSA, OK 74104(918) 748-7810 Get Directions Write a Review

NPPES record last updated: June 27, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 30, 2020, May 22, 2020, Jul 2, 2016 (3 updates tracked since 2016).

About Kenny Susanto Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNY SUSANTO MD (NPI 1255783270) is an individual neurology provider in Tulsa, Oklahoma, licensed in Oklahoma (38794) and active in the NPI registry since July 2016. He is enrolled in Medicare PECOS, is affiliated with Ascension St John Jane Phillips, and is a graduate of Other (2012).

NPPES Registry Identity

NPI1255783270
Entity TypeIndividualMale
Primary Taxonomy2084N0400X
Provider Legal NameKENNY SUSANTOCredential: MD
Location Address2000 S WHEELING AVE STE 701Tulsa, OK 74104-5647
Mailing Address2000 S Wheeling Ave Ste 701Tulsa, OK 74104-5647
Sole ProprietorNo
Medical School CMSOtherGraduated 2012
Enumeration DateJuly 2, 2016
Last NPPES UpdateJune 27, 20223 updates tracked since enumeration
NPPES CertifiedJuly 30, 2020
NPI 1255783270 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0400X
Licenses Licensed in OK · 38794 Licensed in CT · 1.065004 Licensed in GA · 008863
Definition
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.
2000 S WHEELING AVE STE 701, Tulsa, OK 74104

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Kenny Susanto Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1254758410
PECOS Enrollment IDI20220815001112
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 12

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Injection, onabotulinumtoxina, 1 unit J0585
Onabotulinumtoxina, also known as Botox, is a medication injected into muscles. It's used to treat various conditions by blocking nerve activity in the muscles, causing a temporary reduction in muscle activity. The units refer to the dosage.
8,600 services17 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
152 services102 patients
Needle measurement of electrical activity in arm or leg muscles, complete study 95886
This procedure, known as an electromyography (EMG), involves inserting a small needle into your arm or leg muscles to measure their electrical activity. This complete study helps diagnose issues with nerves or muscles, providing valuable data for your treatment plan.
84 services45 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
74 services57 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
53 services53 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
43 services43 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Ascension St John Jane Phillips

Acute Care Hospitals · Bartlesville, OK
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number370018
Location3500 East Frank Phillips BoulevardBartlesville, OK 74006 · Washington County
Emergency services Birthing friendly

Ascension St John Medical Center

Acute Care Hospitals · Tulsa, OK
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number370114
Location1923 South Utica AvenueTulsa, OK 74104 · Tulsa County
Emergency services Birthing friendly

Ascension St John Broken Arrow

Acute Care Hospitals · Broken Arrow, OK
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number370235
Location1000 West Boise CircleBroken Arrow, OK 74012 · Tulsa County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 74104 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$123.06 typical visit price
range $53.00 – $162.61
Typical copayment $30.76 (range $13.25 – $40.65)
Most-billed visit code 99204
Established Patient
$94.27 typical visit price
range $16.68 – $132.40
Typical copayment $23.56 (range $4.17 – $33.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

91.24/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality74.13
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Psychiatry & Neurology (Neurology)
2000 S WHEELING AVE STE 701
TULSA, OK 74104
Nurse Practitioner (Acute Care)
2000 S WHEELING AVE STE 701
TULSA, OK 74104
Psychiatry & Neurology (Neurology)
2000 S WHEELING AVE STE 701
TULSA, OK 74104
Nurse Practitioner (Acute Care)
2000 S WHEELING AVE STE 701
TULSA, OK 74104
Psychiatry & Neurology (Neurology)
2000 S WHEELING AVE STE 701
TULSA, OK 74104
Psychiatry & Neurology (Vascular Neurology)
2000 S WHEELING AVE STE 701
TULSA, OK 74104
Internal Medicine
2000 S WHEELING AVE STE 701
TULSA, OK 74104
Internal Medicine
2000 S WHEELING AVE STE 701
TULSA, OK 74104

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenny Susanto's NPI number?

The NPI number for Kenny Susanto is 1255783270. It was assigned to this individual provider in the NPPES registry on July 2, 2016.

Where is Kenny Susanto located?

Kenny Susanto practices at 2000 S Wheeling Ave Ste 701, Tulsa, OK 74104. The listed phone number is (918) 748-7810.

What is Kenny Susanto's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

Is Kenny Susanto enrolled in Medicare?

Yes. Kenny Susanto is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kenny Susanto accept?

Health plans from Blue Cross and Blue Shield of Oklahoma, CommunityCare, Medica and Mending Health list Kenny Susanto as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Kenny Susanto affiliated with any hospitals?

According to CMS data, Kenny Susanto is affiliated with Ascension St John Jane Phillips, Ascension St John Medical Center and Ascension St John Broken Arrow.

When was this NPI record last updated?

The NPPES record for Kenny Susanto was last updated on June 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.