Samantha Grace Hathaway, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

338813 Issued in NY

Practice address

515 Reynolds Rd
Johnson City, NY 13790-1311

Phone

(607) 798-5510

NPI assigned

Apr 20, 2022

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 Grace Michalek Former name

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Family Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Our Lady of Lourdes Memorial Hospital IncGroup PAC ID 1254237779, 249 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Twin Tier Home Health, Inc Home health agency, Johnson City, NY, CCN 337181
• Our Lady of Lourdes Memorial Hospital, Inc Hospital, Binghamton, NY, CCN 330011

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: smichalek196510@direct-guthrie.org

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.

• Our Lady of Lourdes Memorial Hospital Inc.

  • General Acute Care Hospital
  • Binghamton, NY
  • NPI 1629087580
  Medicare reassignment Care Compare group NPD
• Our Lady of Lourdes Memorial Hospital, Inc.

  • Family Medicine Physician
  • Binghamton, NY
  • NPI 1063557189
  NPD
• Our Lady of Lourdes Memorial Hospital, Inc.

  • Specialty Pharmacy
  • Johnson City, NY
  • NPI 1730982596
  NPD
• Twin Tier Pathology Associates, PC

  • Clinical Pathology/Laboratory Medicine Physician
  • Binghamton, NY
  • NPI 1770577470
  NPD
• Cloud Health Medical Group of New Jersey, P.C.

  • Internal Medicine Physician
  • Union City, NJ
  • NPI 1043995467
  NPD (past)

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

• Our Lady of Lourdes Memorial Hospital Inc.

  • General Acute Care Hospital
  • Binghamton, NY
  • NPI 1629087580
  Care Compare affiliation
• Twin Tier Home Health, Inc.

  • Home Health Agency
  • Johnson City, NY
  • NPI 1760489405
  Care Compare affiliation

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

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1164166708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 SPRINGER RD",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139043404",
            "telephone_number": "845-820-1864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 REYNOLDS RD",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137901311",
            "telephone_number": "607-798-5510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHAWAY",
        "first_name": "SAMANTHA",
        "middle_name": "GRACE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-20",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "338813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "MICHALEK",
            "middle_name": "GRACE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melissa A Haskell
• Kevin Lee Hastings Jr., DO
• Hatala Orthodontics PC
• Mark P Hatala, DDS
• Raven Hathaway, FNP-BC
• Jacqueline M Havriliak, CRNA
• Amy Marie Hawley, NP
• Hayfa Hazar, CRNA
• Megan Hazelton, MS
• HCA

• Family Medicine Physician in Johnson City, NY
• Providers in Johnson City, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; 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.