Samantha Sussek

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9059-123 Issued in WI

Practice address

169 Stark St
Randolph, WI 53956-1298

Phone

(608) 423-6636

NPI assigned

May 31, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Within Reach LLC

  • Clinical Social Worker
  • Randolph, WI
  • NPI 1801420237
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1013278548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 STARK ST",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "539561298",
            "telephone_number": "608-423-6636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 STARK ST",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "539561298",
            "telephone_number": "608-423-6636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSSEK",
        "first_name": "SAMANTHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-31",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9059-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Randolph School District
• Shannon N Sandstrom, NP
• Emily J Seltzner, RD
• Wendy Lunnette Sherwood, IBCLC
• Tara Sosalla
• Patricia Jean Vanburen, RN
• Myriel Jamae Werner, DDS
• Ross D Werner, DDS
• Teresa J Wiersma, NP
• Within Reach LLC

• Clinical Social Worker in Randolph, WI
• Providers in Randolph, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.