Samantha Dorman, PA

Primary specialty

Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X

License

5276 Issued in AZ

Practice address

2204 S Dobson Rd Ste 201
Mesa, AZ 85202-6457

Phone

(602) 230-7373

Fax

(480) 629-8577

NPI assigned

Oct 11, 2012

Last updated

Nov 17, 2023By 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 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

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, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Denova Collaborative Health, LLCGroup PAC ID 2466437736, 141 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: denova.samanthadorman@141317.advancedmd-direct.com
• Direct secure messaging: samantha.dormanpa.p1@direct.tgcaz.nextgenshare.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.

• Denova Collaborative Health, LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1609300854
  Medicare reassignment Care Compare group
• Uhs of Phoenix, LLC

  dba Quail Run Behavioral Health

  • Psychiatric Hospital
  • Phoenix, AZ
  • NPI 1740604636
  Medicare reassignment
• Denova Collaborative Health, LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1710283593
  NPD
• Denova Collaborative Health, LLC

  • Multi-Specialty Clinic/Center
  • Peoria, AZ
  • NPI 1740079060
  NPD
• Horizon Health & Wellness, Inc.

  dba Mountain Health & Wellness

  • Community/Behavioral Health Agency
  • Oracle, AZ
  • NPI 1659458750
  NPD (past)
• Horizon Health and Wellness, Inc.

  • Professional Counselor
  • Globe, AZ
  • NPI 1205931987
  NPD (past)
• Horizon Health and Wellness, Inc.

  • Federally Qualified Health Center (FQHC)
  • Oracle, AZ
  • NPI 1710366737
  NPD (past)

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

{
    "created_epoch": "1349913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1417209644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 N CENTRAL AVE STE 550",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122635",
            "telephone_number": "602-230-7373",
            "fax_number": "602-230-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 S DOBSON RD STE 201",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852026457",
            "telephone_number": "602-230-7373",
            "fax_number": "480-629-8577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORMAN",
        "first_name": "SAMANTHA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-11",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5276",
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "5276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "747718",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sdorman@denova.com",
            "affiliation": "N",
            "endpointDescription": "HIE",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3101 N Central Ave Ste 550",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850122635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Donsky Bogle Dermatology LLC (Grand Canyon Dermatology PLLC)
• Ronda Jo Doolen
• Ailis Clare Dooner, MD
• Elizabeth Persis Dormady, M.A.CCC-SLP
• Megan Bea Dormady
• Tamara R Dorsett, P.A.-C.
• Michelle Lee Dorsey, M.D.
• Dose Wellness LLC
• April Doss
• Jeremy James Dost, DO

• Psychiatric/Mental Health Clinical Nurse Specialist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Psychiatric/Mental Health Clinical Nurse Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; 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.