Samara Daeva Joy Johnson, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2773 Issued in SC

Practice address

15 Royce Dr
Churchville, NY 14428-8900

Phone

(716) 986-3193

NPI assigned

Nov 11, 2019

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594339200000",
    "number": "1225673551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 ROYCE DR",
            "city": "CHURCHVILLE",
            "state": "NY",
            "postal_code": "144288900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 ROYCE DR",
            "city": "CHURCHVILLE",
            "state": "NY",
            "postal_code": "144288900",
            "telephone_number": "716-986-3193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SAMARA",
        "middle_name": "DAEVA JOY",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-11",
        "last_updated": "2020-07-10",
        "certification_date": "2020-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "SC",
            "license": "2773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sjohn23@brockport.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "15 Royce Dr",
            "city": "Churchville",
            "state": "NY",
            "country_code": "US",
            "postal_code": "144288900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Courtney Hayden
• Elizabeth Baltus Hebert, MS OTR
• Alexandra Marie Holmes, MS, OTR/L
• Sandra Iacucci, RN
• Rozetta Johnson, LPN
• Anastasia Keisidis, R.N.
• John F. Kissel, PT
• Kelli Kloch, RN
• Amy Knuuti, RN
• Robin L Langmaid, FNP-C

• Athletic Trainer in Churchville, NY
• Providers in Churchville, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.