Samantha Hayle Pravder, DO

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

OS22678 Issued in FL

Practice address

927 45TH St Ste 201
Mangonia Park, FL 33407-2450

Phone

(561) 844-6363

NPI assigned

Mar 29, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: samantha.pravder.1@27004.direct.athenahealth.com

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.

• Kidz Medical Services

  • Pediatrics Physician
  • Coral Gables, FL
  • NPI 1699909341
  NPD (past)

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

{
    "created_epoch": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764633600000",
    "number": "1083175277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 45TH ST STE 201",
            "city": "MANGONIA PARK",
            "state": "FL",
            "postal_code": "334072450",
            "telephone_number": "561-844-6363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 45TH ST STE 201",
            "city": "MANGONIA PARK",
            "state": "FL",
            "postal_code": "334072450",
            "telephone_number": "561-844-6363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9980 Central Park Blvd N Ste 206",
            "address_purpose": "LOCATION",
            "city": "Boca Raton",
            "state": "FL",
            "postal_code": "334281703",
            "country_code": "US",
            "telephone_number": "561-558-1212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRAVDER",
        "first_name": "SAMANTHA",
        "middle_name": "HAYLE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-29",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "FL",
            "license": "OS22678",
            "primary": true
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NY",
            "license": "316438",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elliot Jay Pearson, MD
• Pediatrix Medical Group Florida Inc
• Pediatrix Medical Group of Florida Inc
• Pediatrix Medical Group of Florida Inc
• Patricia Pollicina Edelstein, LCSW
• Primary Medical Care Center IV, Inc.
• Psychiatry Wellness LLC
• Lauren Patience Purdy, PA-C
• Scott Joseph Raffa, M.D.
• Jonathan Ramirez, DNP, CRNA

• Pediatric Gastroenterology Physician in Mangonia Park, FL
• Providers in Mangonia Park, FL by specialty
• Pediatric Gastroenterology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; 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.