Samantha Anne Berthold, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

94-12835 Issued in KS

Practice address

707 N. Emporia Ave
Wichita, KS 67214

Phone

(316) 858-3460

Fax

(316) 858-3499

NPI assigned

Jun 8, 2026

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

Other names 1

• Samantha Anne Clark Former name

Medicare fee-for-service enrollment

Enrolled in KS

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

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

{
    "created_epoch": "1780876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783468800000",
    "number": "1114850286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 N KANSAS ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672143124",
            "telephone_number": "316-293-2665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N. EMPORIA AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67214",
            "telephone_number": "316-858-3460",
            "fax_number": "316-858-3499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTHOLD",
        "first_name": "SAMANTHA",
        "middle_name": "ANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-06-08",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "94-12835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "CLARK",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heather Berry, OTR/L
• Meghan Rhea Berry, DC
• Michael Berry, LCMFT
• Rachel L Berry, LCMFT
• Elizabeth Berschauer
• Abby Bertholf
• Alexandra Abigail Bertoncino
• Taylor Lynn Bertschy, DO
• Mariah Berumen, PHD
• Mariana Berwerth Pereira, MD

• Family Medicine Physician in Wichita, KS
• Providers in Wichita, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.