Samantha F Frederick, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN203567 Issued in GA

Practice address

228 Riverstone Dr
Canton, GA 30114-5256

Phone

(770) 479-1870

Fax

(770) 479-9705

NPI assigned

Dec 18, 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

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samantha.reeves.p1@direct.gacancer.nextgenshare.com

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.

• NSH Cancer Institute Professional Services G, LLC

  • Hematology & Oncology Physician
  • Sandy Springs, GA
  • NPI 1144571381
  Medicare reassignment NPD
• NSH Cancer Institute Professional Services G LLC

  • Durable Medical Equipment & Medical Supplies
  • Blue Ridge, GA
  • NPI 1629329792
  NPD
• Northside Imaging LLC

  • Diagnostic Radiology Physician
  • Warner Robins, GA
  • NPI 1316394976
  NPD (past)
• NSH Cancer Institute Professional Services G, LLC

  • Hematology & Oncology Physician
  • Atlanta, GA
  • NPI 1124379284
  NPD (past)

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

{
    "created_epoch": "1608249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632960000000",
    "number": "1124614631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 SAVOY DR STE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303411071",
            "telephone_number": "678-288-9555",
            "fax_number": "770-479-1870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 RIVERSTONE DR",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301145256",
            "telephone_number": "770-479-1870",
            "fax_number": "770-479-9705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "SAMANTHA",
        "middle_name": "F",
        "name_prefix": "Ms.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-18",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN203567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "G24488A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003245264A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003245264B",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "samantha.reeves.p1@direct.gacancer.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "228 Riverstone Dr",
            "city": "Canton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301145256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Donna Fox
• Anthony Franco, DPT
• Michael Everett Franklin, PA-C
• Kristen Fraser, M.ED., LPC, NCC
• Ashley Frazier, MT-BC
• Freedom to Blossom
• Mary Teresa Freeman-Walters, MS, MAC, LPC, CPCS
• Jennifer Meriam Freeman
• James Courtney French Jr., M.D.
• Amy Desmond Fresolone

• Nurse Practitioner in Canton, GA
• Providers in Canton, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; 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.