Individual provider Active NPI

Samantha Miller

  • Mental Health Counselor
  • Rochester, MN
National Provider Identifier
1548785603
Registry record updated Nov 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
401 16TH St SE Ste 100
Rochester, MN 55904-7974
Phone
(507) 516-0030
Fax
(507) 516-0031
NPI assigned
Aug 10, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

401 16TH St SE Ste 100
Rochester, MN 55904-7974

Mailing address

1900 Silver Lake Rd NW
New Brighton, MN 55112-1786
Phone (651) 628-9566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20240122002654 MN Practitioner - Mental Health Counselor 8325490709

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1592MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD CurrentSince Oct 19, 2020 Accepting new patients
Family Support Services Inc. Mental Health Past Accepting new patients

Locations

1370 Mendota Heights Rd
Mendota Heights, MN 55120
Phone (651) 583-4447

401 16th St SE
Ste 100
Rochester, MN 55904
Phone (507) 516-0030

3425 40th Ave NW
Ste 101
Rochester, MN 55901
Phone (507) 398-3210

1150 Montreal Ave
Ste 107
Saint Paul, MN 55116
Phone (651) 303-8080

1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1502323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541462400000",
    "number": "1548785603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 16TH ST SE STE 100",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559047974",
            "telephone_number": "507-516-0030",
            "fax_number": "507-516-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-10",
        "last_updated": "2018-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.