Individual provider Active NPI

Sama Patel, LMFT

  • Marriage & Family Therapist
  • Lakeland, FL
National Provider Identifier
1568138089
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MT3770 Issued in FL
Practice address
930 Alicia Rd
Lakeland, FL 33801-2104
Phone
(833) 769-3524
NPI assigned
Aug 17, 2021
Last updated
Nov 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MT3770 FL Primary

Addresses

Primary practice location

930 Alicia Rd
Lakeland, FL 33801-2104

Mailing address

20 Laredo PL
Davie, FL 33324-5553

Other practice location 1

20 Laredo Pl
Davie, FL 33324-5553
Phone (507) 469-2657

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20231211000389 FL Practitioner - Marriage and Family Therapist 0840649398 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Personal Recovery Network LLC CurrentSince Jan 1, 2024 Accepting new patients

Locations

930 Alicia Rd
Lakeland, FL 33801
Phone (863) 680-1950

260 Lookout Pl
Ste 202
Maitland, FL 32751
Phone (407) 537-9450

250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685

Interoperability endpoints

  • Direct secure messaging: fbh.samapatel@141363.advancedmd-direct.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1568138089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 LAREDO PL",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333245553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 ALICIA RD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338012104",
            "telephone_number": "833-769-3524"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 Laredo Pl",
            "address_purpose": "LOCATION",
            "city": "Davie",
            "state": "FL",
            "postal_code": "333245553",
            "country_code": "US",
            "telephone_number": "507-469-2657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "SAMA",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-17",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT3770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.