Samantha Nicole Petty, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209.026134 Issued in IL

Practice address

1808 19TH Ave
Sterling, IL 61081-1676

Phone

(815) 718-2344

NPI assigned

Oct 10, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Forefront-Rosenzweig Medical Services Professional CorporationGroup PAC ID 1052697455, 34 clinicians

Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Osf Saint Katharine Medical Center Hospital, Dixon, IL, CCN 140012

Merit-based Incentive Payment System (MIPS)

Final score

82.78 of 100Reported as group

Quality

60.49

Promoting interoperability

100

Improvement activities

40

Cost

77.11

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samantha.petty.1@24287.direct.athenahealth.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.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment Care Compare group NPD
• Forefront-Rosenzweig Medical Services Professional Corporation

  • Psychiatry Physician
  • Dallas, TX
  • NPI 1588101745

  IL

  Medicare reassignment Care Compare group NPD
• Katherine Shaw Bethea Hospital

  • General Acute Care Hospital
  • Dixon, IL
  • NPI 1427043546
  Medicare reassignment NPD
• KSB Medical Group, Inc.

  • Family Medicine Physician
  • Dixon, IL
  • NPI 1073592119
  Medicare reassignment NPD
• Access Telecare, PLLC

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1013303080

  IL

  Medicare reassignment NPD
• KSB Medical Group, Inc.

  • Eyewear Supplier
  • Dixon, IL
  • NPI 1306814603
  NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD

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

• Osf Healthcare System

  • General Acute Care Hospital
  • Dixon, IL
  • NPI 1508683590
  Care Compare affiliation

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1174248405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 19TH AVE",
            "city": "STERLING",
            "state": "IL",
            "postal_code": "610811676",
            "telephone_number": "815-718-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 19TH AVE",
            "city": "STERLING",
            "state": "IL",
            "postal_code": "610811676",
            "telephone_number": "815-718-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "SAMANTHA",
        "middle_name": "NICOLE",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-10",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209.026134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pedro Peralta, M.D.
• Gilberto Perez, CADC
• Peterson Chiropractic & Sports Injury, S.C.
• Erik D Peterson, D.C.
• Sue Peterson
• Erin N Phalen, P.T.
• Lori L Phalen, PT
• Sarah Ce Phillips
• Jessica Prowant
• Vincent J. Racanelli, DO

• Psychiatric/Mental Health Nurse Practitioner in Sterling, IL
• Providers in Sterling, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; 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.