Samantha Lynn Kersh, FNP, B-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209022459 Issued in IL

Practice address

911 Baytowne Dr SPC 9
Champaign, IL 61822-7994

Phone

(217) 269-6265

NPI assigned

Sep 20, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vitae Health Medical Illinois, PLLCGroup PAC ID 2365798410, 214 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Vitae Health Medical Illinois, PLLC

  • Internal Medicine Physician
  • Skokie, IL
  • NPI 1174013452
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1558031682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 BAYTOWNE DR SPC 9",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618227994",
            "telephone_number": "217-269-6265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 BAYTOWNE DR SPC 9",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618227994",
            "telephone_number": "217-269-6265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERSH",
        "first_name": "SAMANTHA",
        "middle_name": "LYNN",
        "credential": "FNP, B-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-20",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209022459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "NA",
            "affiliation": "N",
            "endpointDescription": "NA",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "NA",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "NA",
            "address_1": "911 Baytowne Dr Spc 9",
            "city": "Champaign",
            "state": "IL",
            "country_code": "US",
            "postal_code": "618227994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kendrick Counseling, PLLC
• Trevor Elizabeth Kendrick, MFT, LMFT
• Dovison Kereri
• Keri Powell Therapy Inc
• Harriet Kersh
• Marissa Kaitlyn Kershner
• Jaime K Kesler, NP
• Kathleen Ann Kessler, MSW, LCSW, ACSW
• Lawrence Howard Kessler, O.D.
• Key Insights Counseling and Consulting

• Family Nurse Practitioner in Champaign, IL
• Providers in Champaign, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; 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.