Individual provider Active NPI

Samantha Warner

  • Occupational Therapist
  • Saint Paul, MN
National Provider Identifier
1104206846
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
104386 Issued in MN
Practice address
1710 Suburban Ave
Saint Paul, MN 55106-6636
Phone
(651) 254-3200
NPI assigned
Jun 8, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 5682-26 WI
Occupational Therapist 225X00000X 104386 MN Primary

Addresses

Primary practice location

1710 Suburban Ave
Saint Paul, MN 55106-6636

Mailing address

612 E Oak St
Glenwood City, WI 54013-8520
Phone (715) 265-4325

Other practice location 1

612 E Oak St
Glenwood City, WI 54013-8520
Phone (715) 265-4325

Other names 1

  • Samantha Shemon Former name

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
104386MNMDOccupational Therapist
5682-26WIMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Regions Hospital Current Accepting new patients
Regions Hospital CurrentSince Apr 1, 2017 Accepting new patients
Regions Hospital CurrentSince Apr 1, 2017 Accepting new patients
Group Health, Inc. CurrentSince Apr 24, 2023 Accepting new patients
Group Health, Inc. CurrentSince Apr 24, 2023 Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

1710 Suburban Ave
Saint Paul, MN 55106
Phone (651) 254-3200

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

Organizations & group practices 5

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": "1433721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1104206846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 E OAK ST",
            "city": "GLENWOOD CITY",
            "state": "WI",
            "postal_code": "540138520",
            "telephone_number": "715-265-4325",
            "fax_number": "715-235-4375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 SUBURBAN AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551066636",
            "telephone_number": "651-254-3200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "612 E Oak St",
            "address_purpose": "LOCATION",
            "city": "Glenwood City",
            "state": "WI",
            "postal_code": "540138520",
            "country_code": "US",
            "telephone_number": "715-265-4325",
            "fax_number": "715-235-4375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WARNER",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-08",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "5682-26",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "104386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "SHEMON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.