Samantha Smith, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

083680 Issued in IA

Practice address

128 Jackson St
Brooklyn, IA 52211-7711

Phone

(641) 522-7221

Fax

(641) 522-5816

NPI assigned

Jul 14, 2016

Last updated

Dec 14, 2016By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in IA

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

Physician Assistant

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grinnell Regional Medical Center Hospital, Grinnell, IA, CCN 160147
• Compass Memorial Healthcare Hospital, Marengo, IA, CCN 161317

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Brian J Heineman, DO

  • Adolescent Medicine (Family Medicine) Physician
  • Brooklyn, IA
  • NPI 1548341035
  Medicare reassignment
• Brian J. Heineman, D.O.

  dba Brooklyn Medical Clinic

  • Family Medicine Physician
  • Brooklyn, IA
  • NPI 1538297940
  NPD (past)
• Grinnell Regional Medical Center

  dba Unitypoint Health - Grinnell Professional Services

  • Family Medicine Physician
  • Grinnell, IA
  • NPI 1437663242
  NPD (past)
• Marengo Memorial Hospital

  dba Brooklyn Family Medical Clinic

  • Rural Health Clinic/Center
  • Brooklyn, IA
  • NPI 1861329203
  NPD (past)

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

• Grinnell Regional Medical Center

  dba Unitypoint Health - Grinnell Regional Medical Center

  • General Acute Care Hospital
  • Grinnell, IA
  • NPI 1669420501
  Care Compare affiliation
• Marengo Memorial Hospital

  dba Compass Memorial Healthcare

  • Critical Access Hospital
  • Marengo, IA
  • NPI 1053368191
  Care Compare affiliation

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

{
    "created_epoch": "1468454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481673600000",
    "number": "1346693314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 JACKSON ST",
            "address_2": "PO BOX 527",
            "city": "BROOKLYN",
            "state": "IA",
            "postal_code": "522117711",
            "telephone_number": "641-522-7221",
            "fax_number": "641-522-5816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 JACKSON ST",
            "city": "BROOKLYN",
            "state": "IA",
            "postal_code": "522117711",
            "telephone_number": "641-522-7221",
            "fax_number": "641-522-5816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SAMANTHA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-14",
        "last_updated": "2016-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "083680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanner Jansen, DC
• Madsen Inc (Brooklyn Family Pharmacy)
• Marengo Memorial Hospital (Brooklyn Family Medical Clinic)
• Melissa Moyer, COTA/L
• Michele Leann Schultz, FNP-BC
• Thompson & Thompson Long Term Care Inc (Brooklyn Pharmacy)
• Town of Brooklyn (East Poweshiek County Ambulance)
• Emily Wagner
• Alan Edward Wiedenman, D.C.

• Medical Physician Assistant in Brooklyn, IA
• Providers in Brooklyn, IA by specialty
• Medical Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; 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.