Individual provider Active NPI

Samantha Mollman, PA-C

  • Physician Assistant
  • Bismarck, ND
National Provider Identifier
1043612609
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC0726 Issued in ND
Practice address
310 N 10TH St
Bismarck, ND 58501-4516
Phone
(701) 530-7500
NPI assigned
Sep 25, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA0004002 CO
Physician Assistant 363A00000X PAC0726 ND Primary

Addresses

Primary practice location

310 N 10TH St
Bismarck, ND 58501-4516

Mailing address

310 N 10TH St
Bismarck, ND 58501-4516
Phone (701) 530-7500

Other identifiers 1

IdentifierTypeStateIssuer
P01579435OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180823002013 ND Practitioner - Physician Assistant 1759698202 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Colorado School of Medicine, Denver, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanford BismarckGroup PAC ID 9739098575, 562 clinicians

Practice addresses (Care Compare)

3318 N 14TH St
Bismarck, ND 58503-1614
Phone (701) 323-8300

4535 Northern Sky Dr
Bismarck, ND 58503-8534
Phone (701) 323-8700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.48 of 100Reported as group
Quality
73.03
Promoting interoperability
100
Improvement activities
40
Cost
71.91

Merit-based Incentive Payment System (MIPS)

Final score
89.63 of 100Reported as group
Quality
89.39
Promoting interoperability
100
Improvement activities
40
Cost
76.04

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PAC0726NDMDPhysician Assistant
PA0004002COMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Bismarck CurrentSince Nov 27, 2023 Accepting new patients
St Alexius Medical Center CurrentSince Jul 23, 2018 Accepting new patients
St. Alexius Medical Center CurrentSince Jul 23, 2018 Accepting new patients

Locations

701 E Rosser Ave
Bismarck, ND 58501
Phone (701) 751-6755

900 E Broadway Ave
Bismarck, ND 58501
Phone (701) 530-7300

3318 N 14th St
Bismarck, ND 58503
Phone (701) 323-8300

310 N 10th St
Bismarck, ND 58501
Phone (701) 530-7500

Interoperability endpoints

  • Direct secure messaging: skisicki305126@achce.catholichealth.net

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1411603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1043612609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 N 10TH ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014516",
            "telephone_number": "701-530-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 N 10TH ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014516",
            "telephone_number": "701-530-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLMAN",
        "first_name": "SAMANTHA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-25",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA0004002",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01579435",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

Verify at the official NPI Registry.