Samantha Lee Bergstein, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.1901939 Issued in OH

Practice address

4041 N High St Ste 300H
Columbus, OH 43214-3200

Phone

(614) 984-4394

Fax

(614) 319-5618

NPI assigned

Dec 18, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Mantra Mental Health, LLC

  • Clinical Social Worker
  • Columbus, OH
  • NPI 1285266445
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1513555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1417463183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4041 N HIGH ST STE 300H",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432143200",
            "telephone_number": "614-984-4394",
            "fax_number": "614-319-5618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 N HIGH ST STE 300H",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432143200",
            "telephone_number": "614-984-4394",
            "fax_number": "614-319-5618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGSTEIN",
        "first_name": "SAMANTHA",
        "middle_name": "LEE",
        "credential": "LISW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-18",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1700637",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1901939",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0413879",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0264054",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Bergman
• Marina Bergman
• Simon Bergman, M.D., M.SC.
• Adele Bergmeier, DO
• Emilie Jean Bergsma, PHARMD
• Brianne Bergstrom, LISW-S
• Reece E. Bergstrom, DO
• Terri Lynn Bergunzi
• Katherine Constance Ruth Bergus, MD
• Samuel Berhane, QBHS3

• Clinical Social Worker in Columbus, OH
• Providers in Columbus, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.