Active NPI
Samantha Rivera, MD
- Hospitalist Physician
- Saint Louis, MO
National Provider Identifier
1568029593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- 2022027040
- Practice address
- 11133 Dunn Rd Ste 2427
Saint Louis, MO 63136-6163 - Phone
- (314) 653-5643
- NPI assigned
- May 24, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2022027040 | MO | |
| Hospitalist Physician | 208M00000X | 2022027040 | MO | Primary |
Addresses
Primary practice location
11133 Dunn Rd Ste 2427
Saint Louis, MO 63136-6163
Mailing address
11133 Dunn Rd Ste 2427
Saint Louis, MO 63136-6163
Phone (314) 653-5643
Other practice location 1
425 Wind Ridge Dr
Wausau, WI 54401-4149
Phone (715) 675-3391
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Hospitalist
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
11133 Dunn Rd
Suite 2427
Saint Louis, MO 63136-6163
Phone (314) 653-5643
Hospital & facility affiliations
- BJC Hospice
- Christian Hospital Northeast
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Groups LC | Current | Accepting new patients | |
| Physician Groups LC | Family Medicine | Current | Accepting new patients |
| Christian Hospital Northeast- Northwest | Past | Accepting new patients |
Locations
2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454
11133 Dunn Rd
Ste 2427
Saint Louis, MO 63136
Phone (314) 653-5643
Interoperability endpoints
- https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
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.
-
- Multi-Specialty Clinic/Center
- Farmington, MO
- NPI 1427114990
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1639186760
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Community Based Hospice Care Agency
- Saint Louis, MO
- NPI 1891705547
-
- General Acute Care Hospital
- Saint Louis, MO
- NPI 1639186760
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659398400000",
"number": "1568029593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11133 DUNN RD STE 2427",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631366163",
"telephone_number": "314-653-5643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11133 DUNN RD STE 2427",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631366163",
"telephone_number": "314-653-5643"
}
],
"practiceLocations": [
{
"address_1": "425 Wind Ridge Dr",
"address_purpose": "LOCATION",
"city": "Wausau",
"state": "WI",
"postal_code": "544014149",
"country_code": "US",
"telephone_number": "715-675-3391",
"fax_number": "715-675-5262",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RIVERA",
"first_name": "SAMANTHA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-24",
"last_updated": "2022-08-02",
"certification_date": "2022-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": "2022027040",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "MO",
"license": "2022027040",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
"affiliation": "N",
"endpointDescription": "BJC",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "11133 Dunn Rd Ste 2427",
"city": "Saint Louis",
"state": "MO",
"country_code": "US",
"postal_code": "631366163",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.