Individual provider Active NPI

Samantha Marie Cunningham, APRN

  • Family Nurse Practitioner
  • Sioux City, IA
National Provider Identifier
1134551880
Registry record updated Nov 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CP003105 Issued in SD
Practice address
5006 Sergeant Rd # 123
Sioux City, IA 51106-4708
Phone
(402) 799-8042
Fax
(402) 702-1269
NPI assigned
Aug 5, 2013
Last updated
Nov 3, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 111559 NE
Acute Care Nurse Practitioner 363LA2100X 111559 NE
Family Nurse Practitioner 363LF0000X H177489 IA
Family Nurse Practitioner 363LF0000X CP003105 SD Primary

Addresses

Primary practice location

5006 Sergeant Rd # 123
Sioux City, IA 51106-4708

Mailing address

5006 Sergeant Rd # 123
Sioux City, IA 51106-4708
Phone (402) 799-8042

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE, IA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20131112000311 NE Practitioner - Nurse Practitioner 0244466787 Reassigns benefits to 1 organization
I20250710000252 IA Practitioner - Nurse Practitioner 0244466787 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Clinic IncGroup PAC ID 4880506062, 557 clinicians

Practice addresses (Care Compare)

933 E Pierce St
Methodist Jennie Edmundson
Council Bluffs, IA 51503-4626
Phone (712) 396-7495

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
111559NEMDAcute Care Nurse Practitioner
CP003105SDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
My Elevated Wellness PLLC CurrentSince May 25, 2025 Accepting new patients
Physicians Clinic Inc Nurse Practitioner CurrentSince Jul 31, 2025 Accepting new patients

Locations

1 Edmundson Pl
Council Bluffs, IA 51503
Phone (712) 396-4000

933 E Pierce St
Council Bluffs, IA 51503
Phone (712) 328-6000

450 E 23rd St
Fremont, NE 68025
Phone (402) 721-1610

825 S 169th St
Omaha, NE 68118
Phone (402) 354-3370

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1375660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762128000000",
    "number": "1134551880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5006 SERGEANT RD # 123",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511064708",
            "telephone_number": "402-799-8042",
            "fax_number": "402-702-1269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5006 SERGEANT RD # 123",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511064708",
            "telephone_number": "402-799-8042",
            "fax_number": "402-702-1269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "SAMANTHA",
        "middle_name": "MARIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-05",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NE",
            "license": "111559",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NE",
            "license": "111559",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "H177489",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SD",
            "license": "CP003105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

Verify at the official NPI Registry.