Active NPI
Sheeba Samuel
- Psychiatric/Mental Health Nurse Practitioner
- Buford, GA
National Provider Identifier
1154923563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 273587
- Practice address
- 2949 Heart Pine Way
Buford, GA 30519-7639 - Phone
- (972) 675-9238
- NPI assigned
- Nov 10, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 273587 | GA | Primary |
Addresses
Primary practice location
2949 Heart Pine Way
Buford, GA 30519-7639
Mailing address
2949 Heart Pine Way
Buford, GA 30519-7639
Phone (972) 675-9238
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210216000357 | GA | Practitioner - Nurse Practitioner | 1355756859 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Personal Recovery Network LLC | Current | Accepting new patients |
Locations
2055 Sugarloaf Cir
Ste 575
Duluth, GA 30097
Phone (404) 999-7971
250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604966400000",
"number": "1154923563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2949 HEART PINE WAY",
"city": "BUFORD",
"state": "GA",
"postal_code": "305197639",
"telephone_number": "972-675-9238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2949 HEART PINE WAY",
"city": "BUFORD",
"state": "GA",
"postal_code": "305197639",
"telephone_number": "972-675-9238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "SHEEBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-10",
"last_updated": "2020-11-10",
"certification_date": "2020-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "GA",
"license": "273587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buford, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; 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.