Individual provider Active NPI

Samantha Patricia Dalessio, RN

  • Family Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1508529504
Registry record updated Feb 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
270749 Issued in AZ
Practice address
6410 W Mark LN
Phoenix, AZ 85083-7678
Phone
(623) 249-9096
NPI assigned
Oct 16, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN215995 AZ
Family Nurse Practitioner 363LF0000X 270749 AZ Primary

Addresses

Primary practice location

6410 W Mark LN
Phoenix, AZ 85083-7678

Mailing address

6410 W Mark LN
Phoenix, AZ 85083-7678
Phone (623) 249-9096

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220425000357 AZ Practitioner - Nurse Practitioner 2860889789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner Hospital Based Physicians Arizona LLCGroup PAC ID 3274782487, 636 clinicians

Practice addresses (Care Compare)

14502 W Meeker Blvd
Sun City, AZ 85375-5282
Phone (623) 524-4000

Hospital & facility affiliations

  • Banner Boswell Medical Center Hospital, Sun City, AZ, CCN 030061
  • Banner del E. Webb Medical Center Hospital, Sun City West, AZ, CCN 030093

Merit-based Incentive Payment System (MIPS)

Final score
83.7 of 100Reported as group
Quality
64.97
Promoting interoperability
98
Improvement activities
40
Cost
69.88

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN215995AZMDRegistered Nurse
270749AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Mar 17, 2022 Accepting new patients
Banner Hospital Based Physicians Arizona LLC Current Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Mar 17, 2022 Accepting new patients

Locations

5555 W Thunderbird Rd
Glendale, AZ 85306
Phone (602) 588-5555

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

9201 W Thomas Rd
Phoenix, AZ 85037
Phone (623) 327-4000

37000 N Gantzel Rd
San Tan Valley, AZ 85140
Phone (480) 394-4000

10401 W Thunderbird Blvd
Sun City, AZ 85351
Phone (623) 815-7690

14502 W Meeker Blvd
Sun City West, AZ 85375
Phone (623) 214-4000

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1634342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646006400000",
    "number": "1508529504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6410 W MARK LN",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850837678",
            "telephone_number": "623-249-9096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 W MARK LN",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850837678",
            "telephone_number": "623-249-9096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALESSIO",
        "first_name": "SAMANTHA",
        "middle_name": "PATRICIA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-16",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN215995",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "270749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.