Samantha L Thiede, APNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

10152 Issued in WI

Practice address

608 W Brown St
Waupun, WI 53963-1788

Phone

(920) 324-6801

NPI assigned

Jul 20, 2020

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

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

Agnesian Healthcare IncGroup PAC ID 1658289624, 392 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Waupun Memorial Hospital Hospital, Waupun, WI, CCN 521327
• SSM Health St Agnes Hospital-Fond Du Lac Hospital, Fond Du Lac, WI, CCN 520088

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Agnesian Healthcare, Inc

  • General Acute Care Hospital
  • Fond Du Lac, WI
  • NPI 1346228541
  Medicare reassignment Care Compare group NPD
• Agnesian Healthcare Inc

  • Community/Retail Pharmacy
  • Waupun, WI
  • NPI 1366417917
  NPD
• Agnesian Healthcare Inc

  • Family Medicine Physician
  • Fond Du Lac, WI
  • NPI 1730162991
  NPD

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

• Agnesian Healthcare, Inc

  • General Acute Care Hospital
  • Fond Du Lac, WI
  • NPI 1346228541
  Care Compare affiliation
• Waupun Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Waupun, WI
  • NPI 1528046737
  Care Compare affiliation
• Waupun Memorial Hospital

  • Critical Access Hospital
  • Waupun, WI
  • NPI 1548248644
  Care Compare affiliation

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

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651622400000",
    "number": "1306454053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 W BROWN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631788",
            "telephone_number": "920-324-6801",
            "fax_number": "920-324-8439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 W BROWN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631788",
            "telephone_number": "920-324-6801"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1818 N Meade St",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549113454",
            "country_code": "US",
            "telephone_number": "920-735-7645",
            "fax_number": "920-735-7618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIEDE",
        "first_name": "SAMANTHA",
        "middle_name": "L",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-20",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "10152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sthiede399241@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "sthiede399241@direct-ehr-ssmhc.com",
            "address_1": "608 W Brown St",
            "city": "Waupun",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539631788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIRAPI",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "608 W Brown St",
            "city": "Waupun",
            "state": "WI",
            "country_code": "US",
            "postal_code": "539631788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Olly Christian Stewart, PT, DPT
• Kathryn Therese Sullivan Dillie, MD, PHD
• Jessica Y Sullivan, NP
• Paul Henry Sumnicht, M.D.
• Tammy Narance LPC SC
• Donna L Thomas, OTR, CKTP
• Peter W Timmermans, MD
• Amy J. Tisdale, LPN
• Torria Van Buren, PSY.D
• Van'S Corner Drug

• Nurse Practitioner in Waupun, WI
• Providers in Waupun, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.