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SUSAN KELLY NIEBAUM PMHNP-BC
NPI 1861165839
Nurse Practitioner - Psychiatric/Mental Health in South Salt Lake, UT

Active since July 27, 2021PECOS Enrolled
408 E KELSEY VIEW LN, SOUTH SALT LAKE, UT 84115(406) 212-2177 Get Directions Write a Review

NPPES record last updated: February 3, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Feb 3, 2022, Jul 27, 2021 (2 updates tracked since 2021).

About Susan Kelly Niebaum Pmhnp-bc NPPES

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

SUSAN KELLY NIEBAUM PMHNP-BC (NPI 1861165839) is an individual psychiatric/mental health provider in South Salt Lake, Utah, licensed in Utah (12585557-4405) and active in the NPI registry since July 2021. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1861165839
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameSUSAN KELLY NIEBAUMCredential: PMHNP-BC
Location Address408 E KELSEY VIEW LNSouth Salt Lake, UT 84115-4979
Mailing Address408 E Kelsey View LnSouth Salt Lake, UT 84115-4979 · (406) 212-2177
Phone(406) 212-2177
Sole ProprietorYes
Enumeration DateJuly 27, 2021
Last NPPES UpdateFebruary 3, 20222 updates tracked since enumeration
NPPES CertifiedFebruary 3, 2022
✔ NPI 1861165839 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in UT · 12585557-4405
Also ListedRegistered Nurse · Psychiatric/Mental Health, Child & AdolescentTaxonomy 163WP0807X · License 16869 (MT)
408 E KELSEY VIEW LN, South Salt Lake, UT 84115
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Susan Kelly Niebaum Pmhnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84115 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
$84.41 typical visit price
range $54.34 – $166.03
Typical copayment $21.10 (range $13.58 – $41.50)
Most-billed visit code 99203
Established Patient
$96.35 typical visit price
range $17.23 – $135.20
Typical copayment $24.08 (range $4.30 – $33.80)
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.

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 Susan Niebaum's NPI number?

The NPI number for Susan Niebaum is 1861165839. It was assigned to this individual provider in the NPPES registry on July 27, 2021.

Where is Susan Niebaum located?

Susan Niebaum practices at 408 E Kelsey View Ln, South Salt Lake, UT 84115. The listed phone number is (406) 212-2177.

What is Susan Niebaum's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Susan Niebaum enrolled in Medicare?

Yes. Susan Niebaum is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Susan Niebaum was last updated on February 3, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.