Samantha Jean Sullivan, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

096840 Issued in IA

Practice address

5627 NW 86TH St Ste 200
Johnston, IA 50131-1738

Phone

(515) 270-0303

Fax

(515) 270-0160

NPI assigned

Jul 16, 2019

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

Other names 1

• Dr. Samantha Jean Forehead Former name

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bartek Therapy Services, Inc.Group PAC ID 7113906447, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Bartek Therapy Services, Inc.

  • Physical Therapist
  • Johnston, IA
  • NPI 1306899562
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1508418930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5627 NW 86TH ST STE 200",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501311738",
            "telephone_number": "515-270-0303",
            "fax_number": "515-270-0160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5627 NW 86TH ST STE 200",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501311738",
            "telephone_number": "515-270-0303",
            "fax_number": "515-270-0160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1810 SW White Birch Cir Ste 107",
            "address_purpose": "LOCATION",
            "city": "Ankeny",
            "state": "IA",
            "postal_code": "500237226",
            "country_code": "US",
            "telephone_number": "515-964-8885",
            "fax_number": "515-964-4557",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SAMANTHA",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-16",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "096840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "FOREHEAD",
            "middle_name": "JEAN",
            "prefix": "DR.",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Steve Straw, R.PH.
• Abigail Stromley
• Claire Studer
• Laura Ann Sturm, MS
• Melanie Sullivan
• Bryan Scott Sumner, DPT
• Sun Drug Village Square LTD
• Sun Drug Village Square LTD
• Sunbeam Trails Therapy LLC
• Supreme Health

• Physical Therapist in Johnston, IA
• Providers in Johnston, IA by specialty
• Physical Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.