Jennifer Sam

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704248128 Issued in MI

Practice address

13045 Michael Dr
Shelby Township, MI 48315-4744

Phone

(248) 225-1959

NPI assigned

Apr 6, 2012

Last updated

May 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jennifer.sam.1@18773.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Core Psych PLLC

  • Psychiatry Physician
  • Dearborn, MI
  • NPI 1871069039
  Medicare reassignment NPD
• Henry Ford Health Eastwood Behavioral Health

  dba Eastwood Clinics

  • Social Worker
  • Clinton Township, MI
  • NPI 1396787701
  Medicare reassignment NPD
• Henry Ford Health Macomb Oakland Hospital

  dba Henry Ford Warren Hospital

  • Nurse Practitioner
  • Warren, MI
  • NPI 1578696092
  Medicare reassignment NPD
• Henry Ford Macomb Hospital Corporation

  dba Henry Ford Macomb Health Center Chesterfield

  • Nurse Practitioner
  • Chesterfield, MI
  • NPI 1952440521
  Medicare reassignment NPD
• Arman C. Moshyedi, MD, PLLC

  • Psychiatry Physician
  • Livonia, MI
  • NPI 1700440203
  Medicare reassignment
• Henry Ford Macomb Hospital Corporation

  dba Henry Ford Health Macomb Hospital

  • General Acute Care Hospital
  • Clinton TWP, MI
  • NPI 1023114634
  NPD
• Henry Ford Macomb Hospital Corporation

  • Neonatal Nurse Practitioner
  • Clinton Township, MI
  • NPI 1912301094
  NPD
• Henry Ford Health Eastwood Behavioral Health

  dba Eastwood Clinics

  • Psychologist
  • Saint Clair Shores, MI
  • NPI 1104044676
  NPD (past)

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

{
    "created_epoch": "1333670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1336405059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13045 MICHAEL DR",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483153952",
            "telephone_number": "248-225-1959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13045 MICHAEL DR",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483154744",
            "telephone_number": "248-225-1959"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "210 W University Dr Ste 6D",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MI",
            "postal_code": "483071975",
            "country_code": "US",
            "telephone_number": "586-330-0659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAM",
        "first_name": "JENNIFER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-06",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704248128",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704248128",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704248128",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rita Salim, DDS
• Steven Wayne Salminen, PT
• Cindy Salmo Bitti
• Salta of Shelby Township PLLC
• Salvation Army Harbor Light Macomb
• Chrestina Nameer Samona
• Angelina W Samuel
• Bennet Samuel
• Megan Elizabeth Sand, CRNA
• Sanitas Home Help Systems LLC

• Psychiatric/Mental Health Nurse Practitioner in Shelby Township, MI
• Providers in Shelby Township, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.