Samantha Michelle Kaczmarek, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704311772 Issued in MI

Practice address

888 W. Big Beaver Rd. Ste 900
Troy, MI 48084

Phone

(248) 629-2880

Fax

(248) 319-6493

NPI assigned

Dec 3, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Miss Samantha Michelle Johnson Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Custom Hospice, LLCGroup PAC ID 8820242993, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Custom Home Health Home health agency, Troy, MI, CCN 237707

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Custom Hospice, LLC

  • Adult Health Nurse Practitioner
  • Troy, MI
  • NPI 1306480538
  Medicare reassignment Care Compare group NPD
• Fadi Salloum MD PC

  • Internal Medicine Physician
  • Pontiac, MI
  • NPI 1053510446
  Medicare reassignment NPD
• Telemed Consultants PLLC

  • Internal Medicine Physician
  • Pontiac, MI
  • NPI 1699398347
  NPD (past)

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

• Custom Home Health, Inc.

  • Home Health Agency
  • Troy, MI
  • NPI 1346251600
  Care Compare affiliation

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

{
    "created_epoch": "1575331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1154968667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 W. BIG BEAVER RD. STE 900",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48084",
            "telephone_number": "248-629-2880",
            "fax_number": "248-319-6493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 W. BIG BEAVER RD. STE 900",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48084",
            "telephone_number": "248-629-2880",
            "fax_number": "248-319-6493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACZMAREK",
        "first_name": "SAMANTHA",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-03",
        "last_updated": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704311772",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704311772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14589057",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "JOHNSON",
            "middle_name": "MICHELLE",
            "prefix": "MISS",
            "credential": "FNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• K Riley Agency, LLC
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• Kacy Family Dentistry, PC
• Bryan D. Kacy, DDS
• Donald R. Kacy, DDS
• Jill Spencer Kaczor, M.S.W.
• Dominick Kada
• Natalie Lynn Kade, MS
• Matina Kadilli, PHARMD
• Umima Kadir

• Family Nurse Practitioner in Troy, MI
• Providers in Troy, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.