Samantha Gwen Brock, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

01083831A Issued in IN

Practice address

4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600

Phone

(702) 653-3898

NPI assigned

Apr 10, 2018

Last updated

Aug 12, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1104323880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-3898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-3898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 W Charleston Blvd",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891022386",
            "country_code": "US",
            "telephone_number": "702-383-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "128 E. Apple St.",
            "address_2": "WCHE 7th Floor",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "45409",
            "country_code": "US",
            "telephone_number": "937-208-4953",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "51ST MDG",
            "address_2": "Unit 2060, 51st Medical Group",
            "address_purpose": "LOCATION",
            "city": "APO",
            "state": "AP",
            "postal_code": "962782060",
            "country_code": "US",
            "telephone_number": "315-784-0196",
            "country_name": "United States",
            "address_type": "MIL"
        },
        {
            "address_1": "1060 W Perimeter Rd # R",
            "address_purpose": "LOCATION",
            "city": "Jb Andrews",
            "state": "MD",
            "postal_code": "207626602",
            "country_code": "US",
            "telephone_number": "240-612-2464",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "128 E. Apple St.",
            "address_2": "WCHE 7th Floor",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "45409",
            "country_code": "US",
            "telephone_number": "937-208-4953",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4881 Sugar Maple Dr",
            "address_purpose": "LOCATION",
            "city": "Wright Patterson AFB",
            "state": "OH",
            "postal_code": "454335529",
            "country_code": "US",
            "telephone_number": "937-257-8715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCK",
        "first_name": "SAMANTHA",
        "middle_name": "GWEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-10",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01083831A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frances E Bradley, CRNA
• Khalia N Branch, DDS
• Virgil Earl Breckenridge Jr.
• April Bressler, PT
• Daniel B Brewer, M.D.
• Linda Brooks, LCSW
• Alexander K Brown, PHARMD
• Bradly Scott Brown, MD
• Kaessee L Brown, M.D.
• Alexis Anthony Brownandia Jr.

• Surgery Physician in Nellis AFB, NV
• Providers in Nellis AFB, NV by specialty
• Surgery Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.