Samantha Macy Peters

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

28956 Issued in MN

Practice address

6500 Excelsior Blvd
St Louis Park, MN 55426-4702

Phone

(952) 993-3123

NPI assigned

May 18, 2023

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 MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Fairview Express Care

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  Medicare reassignment NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment
• Fairview Express Care

  • General Practice Physician
  • Saint Paul, MN
  • NPI 1346722675
  NPD
• Fairview Express Care

  • General Practice Physician
  • Edina, MN
  • NPI 1831707207
  NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593
  NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • Brooklyn Park, MN
  • NPI 1447668678
  NPD

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

{
    "created_epoch": "1684368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771545600000",
    "number": "1104517291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264702",
            "telephone_number": "952-993-3123"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2312 S 6th St # F198",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554541336",
            "country_code": "US",
            "telephone_number": "612-273-5640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERS",
        "first_name": "SAMANTHA",
        "middle_name": "MACY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-18",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "28956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cindy L Persson
• Christina Michelle Pesonen, APRN, CNP
• Kathleen S Peter
• Joy Marie Petermann, MSW LICSW
• Amanda Leigh Peters, PT
• Ann S Petersen, PHARMD.
• Carol Ann Petersen, LICSW
• Jon Walter Petersen, MA, M.ED, LPCC, CMHC
• Lydia Petersen, LGSW, LADC
• Bradley J Peterson, MD

• Clinical Social Worker in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.