Samantha Elaine Shoultz, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71010484A Issued in IN

Practice address

3922 Venetian Way
St 2
Newburgh, IN 47630

Phone

(812) 999-3277

Fax

(812) 518-1722

NPI assigned

Oct 20, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Evansville Colorectal Surgery LLCGroup PAC ID 6204296023, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent Evansville Hospital, Evansville, IN, CCN 150100
• Deaconess Hospital Inc Hospital, Evansville, IN, CCN 150082
• Memorial Hospital and Health Care Center Hospital, Jasper, IN, CCN 150115

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sshoultz73176@direct.deaconess.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.

• Evansville Colorectal Surgery, LLC

  • Acute Care Nurse Practitioner
  • Newburgh, IN
  • NPI 1578253977
  Medicare reassignment Care Compare group NPD
• Pain Management Centers of America, PSC

  • Interventional Pain Medicine Physician
  • Evansville, IN
  • NPI 1992271811
  Medicare reassignment NPD
• Tri-State Colorectal Group, LLC

  • Colon & Rectal Surgery Physician
  • Evansville, IN
  • NPI 1083130751
  Medicare reassignment NPD
• Owensboro Dermatology Associates, PSC

  dba Henderson Dermatology

  • Dermatology Physician
  • Owensboro, KY
  • NPI 1821130295
  NPD (past)

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

• Deaconess Hospital Inc

  dba The Women's Hospital

  • General Acute Care Hospital
  • Newburgh, IN
  • NPI 1780535427
  Care Compare affiliation
• Deaconess Hospital, Inc.

  • General Acute Care Hospital
  • Evansville, IN
  • NPI 1053361642
  Care Compare affiliation
• Deaconess Memorial Medical Center, Inc.

  dba Memorial Hospital & Health Care Center

  • General Acute Care Hospital
  • Jasper, IN
  • NPI 1003895947
  Care Compare affiliation
• St. Mary's Health, Inc.

  dba Ascension St. Vincent Evansville

  • General Acute Care Hospital
  • Evansville, IN
  • NPI 1427082957
  Care Compare affiliation

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

{
    "created_epoch": "1445299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1225400070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3922 VENETIAN WAY",
            "address_2": "ST 2",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "47630",
            "telephone_number": "812-999-3277",
            "fax_number": "812-518-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3922 VENETIAN WAY",
            "address_2": "ST 2",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "47630",
            "telephone_number": "812-999-3277",
            "fax_number": "812-518-1722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOULTZ",
        "first_name": "SAMANTHA",
        "middle_name": "ELAINE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-20",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28224617A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71010484A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darrel Bruce Shelton, MD
• Derek S Shelton, ARNP
• Kimberly S. Shimer, MD
• Daniel Ray Shirey, MD
• Bailey Shoulders, RBT
• Robert Corry Shumate, D.M.D.
• Irfan Ahmed Siddiqui, M.D.
• Daniel Sigler
• Savannah Sikes
• Elisa Simmons, RDN, CDN

• Nurse Practitioner in Newburgh, IN
• Providers in Newburgh, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.