Samantha Jo Moody, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704314094 Issued in MI

Practice address

658 E Main St
Centreville, MI 49032-9627

Phone

(269) 467-3228

NPI assigned

Nov 2, 2020

Sex

Female

Sole proprietor

No

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 MI

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Covered Bridge Healthcare of St. Joseph County IncGroup PAC ID 6507157773, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Three Rivers Health Hospital, Three Rivers, MI, CCN 230015
• Sturgis Hospital Hospital, Sturgis, MI, CCN 230779

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/ABDFAD

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.

• Covered Bridge Healthcare of St. Joseph County Inc

  • Federally Qualified Health Center (FQHC)
  • Centreville, MI
  • NPI 1063876910
  Medicare reassignment Care Compare group NPD

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

• Sturgis Hospital, Inc.

  • Rural Acute Care Hospital
  • Sturgis, MI
  • NPI 1598099699
  Care Compare affiliation
• Three Rivers Health System, Inc

  • General Acute Care Hospital
  • Three Rivers, MI
  • NPI 1568739423
  Care Compare affiliation

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

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1093316663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 LINDA LN",
            "city": "COLDWATER",
            "state": "MI",
            "postal_code": "490361035",
            "telephone_number": "269-625-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "658 E MAIN ST",
            "city": "CENTREVILLE",
            "state": "MI",
            "postal_code": "490329627",
            "telephone_number": "269-467-3228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOODY",
        "first_name": "SAMANTHA",
        "middle_name": "JO",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-02",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704314094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristi Merrills, LMSW
• Vicky Merrills, MSW LMSW CACI
• Grae Mackenzie Miller, LLMSW,DP-C
• Kathy A. Miller, RN
• Mark Edward Montcalm, PHARM.D.
• Alyssia J. Moord, LLMSW
• Karina Moreno
• John Morrill
• Christina E Morrison
• Michael Morrison

• Family Nurse Practitioner in Centreville, MI
• Providers in Centreville, MI by specialty
• Family Nurse Practitioner in Michigan

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