Individual provider Active NPI

Samantha May Stevens, PA-C

  • Physician Assistant
  • Cicero, NY
National Provider Identifier
1336988401
Registry record updated Feb 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
032757 Issued in NY
Practice address
5586 Legionnaire Dr Ste 1
Cicero, NY 13039-3504
Phone
(315) 699-2837
NPI assigned
May 20, 2024
Last updated
Feb 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 032757 NY Primary

Addresses

Primary practice location

5586 Legionnaire Dr Ste 1
Cicero, NY 13039-3504

Mailing address

5100 Highbridge St Apt 32a
Fayetteville, NY 13066-2446
Phone (315) 264-7968

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20241031000672 NY Practitioner - Physician Assistant 7214460138 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
State University of Ny Upstate Medical University, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

Practice addresses (Care Compare)

4101 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 637-7878

4103 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 744-1500

4117 Medical Ctr Dr
Fayetteville, NY 13066-6600
Phone (315) 744-1551

5100 W Taft Rd
Liverpool, NY 13088-4841

7250 Janus Park Dr
Liverpool, NY 13088-4839
Phone (315) 475-8402

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Medical PC Current Accepting new patients
Family Medicine Associates of Central New York, P.C. PastSince May 26, 2024 Accepting new patients

Locations

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770940800000",
    "number": "1336988401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 HIGHBRIDGE ST APT 32A",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130662446",
            "telephone_number": "315-264-7968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5586 LEGIONNAIRE DR STE 1",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "130393504",
            "telephone_number": "315-699-2837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "SAMANTHA",
        "middle_name": "MAY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-20",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "032757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cicero, NY

Sources for this page

Verify at the official NPI Registry.