Individual provider Active NPI

Samantha Good, QMHS

  • Social Worker
  • Adrian, MI
National Provider Identifier
1063917789
Registry record updated May 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
S.1803204 Issued in OH
Practice address
1040 S Winter St Ste 1022
Adrian, MI 49221-3876
Phone
(517) 263-8905
NPI assigned
Mar 26, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X S.1803204 OH Primary

Addresses

Primary practice location

1040 S Winter St Ste 1022
Adrian, MI 49221-3876

Mailing address

1040 S Winter St Ste 1022
Adrian, MI 49221-3876
Phone (517) 263-8905

Other practice location 1

5164 Monroe St
Toledo, OH 43623-3471
Phone (419) 720-9586

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
S.1803204OHMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
A Renewed Mind Past Accepting new patients
Brain Bright Therapy LLC PastSince Jun 1, 2017 Accepting new patients
Lenawee Community Mental Health Authority Past Accepting new patients
Lenawee Community Mental Health Authority PastSince Oct 1, 2001 Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557187200000",
    "number": "1063917789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 S WINTER ST STE 1022",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492213876",
            "telephone_number": "517-263-8905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 S WINTER ST STE 1022",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492213876",
            "telephone_number": "517-263-8905"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5164 Monroe St",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436233471",
            "country_code": "US",
            "telephone_number": "419-720-9586",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOOD",
        "first_name": "SAMANTHA",
        "credential": "QMHS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-26",
        "last_updated": "2019-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1803204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Adrian, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.