Individual provider Active NPI

Samantha Moore

  • Physical Therapist
  • Summit, MS
National Provider Identifier
1598197576
Registry record updated Mar 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
4109 Highway 98 W
Summit, MS 39666-9132
Phone
(601) 276-3900
NPI assigned
Aug 1, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 8, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

4109 Highway 98 W
Summit, MS 39666-9132

Mailing address

4109 Highway 98 W
Summit, MS 39666-9132

Other practice location 1

401 Baptist Dr Ste 306
Madison, MS 39110-2012
Phone (601) 607-7204

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170403000300 MS Practitioner - Physical Therapist in Private Practice 1254616303 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

401 Baptist Dr
Suite 306
Madison, MS 39110-2012
Phone (601) 607-7204

Merit-based Incentive Payment System (MIPS)

Final score
78.38 of 100Reported as group
Quality
54.22
Promoting interoperability
100
Improvement activities
40
Cost
73.72

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Drayer Physical Therapy Mississippi LLC Physical Therapist CurrentSince Mar 7, 2017 Accepting new patients
Medical Foundation of Central Mississippi, Inc CurrentSince Feb 5, 2019 Accepting new patients
Medical Foundation of Central Ms CurrentSince Feb 5, 2019 Accepting new patients
Dpti Elite Physical Therapy LLC Physical Therapist CurrentSince Mar 7, 2017 Accepting new patients
Dpti Elite Physical Therapy LLC Physical Therapist Current Accepting new patients
Medical Foundation of Central Mississippi, Inc. Physical Therapist Current Accepting new patients
Drayer Physical Therapy Institute LLC Physical Therapist Past Accepting new patients
Drayer Physical Therapy Mississippi LLC Physical Therapist Past Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

108 Clinton Pkwy
Clinton, MS 39056
Phone (601) 926-2018

199 N Brookmoore Dr
Columbus, MS 39705
Phone (662) 798-0108

117 Bo Bo Dr
Crystal Springs, MS 39059
Phone (601) 892-6330

4301 Lakeland Dr
Flowood, MS 39232
Phone (601) 939-7010

151 E Metro Dr
Ste 202
Flowood, MS 39232
Phone (601) 973-1507

102 Lexington Dr
#100
Gluckstadt, MS 39110
Phone (601) 973-1688

6250 Old Canton Rd
Ste 130
Jackson, MS 39211
Phone (601) 956-7280

1200 N State St
Ste 210
Jackson, MS 39202
Phone (601) 714-3202

1225 N State St
Jackson, MS 39202
Phone (601) 292-4261

401 Baptist Dr
Ste 306
Madison, MS 39110
Phone (601) 607-7204

401 Baptist Dr
Ste 104
Madison, MS 39110
Phone (601) 605-2383

950 E County Line Rd
Ste D
Ridgeland, MS 39157
Phone (601) 899-0002

2319 Highway 145
Saltillo, MS 38866
Phone (662) 869-9980

513 Academy Rd
Starkville, MS 39759
Phone (662) 268-8013

746 E Fifteenth St
Yazoo City, MS 39194
Phone (662) 746-4032

Organizations & group practices 8

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": "1375315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552003200000",
    "number": "1598197576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4109 HIGHWAY 98 W",
            "city": "SUMMIT",
            "state": "MS",
            "postal_code": "396669132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4109 HIGHWAY 98 W",
            "city": "SUMMIT",
            "state": "MS",
            "postal_code": "396669132",
            "telephone_number": "601-276-3900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Baptist Dr Ste 306",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "MS",
            "postal_code": "391102012",
            "country_code": "US",
            "telephone_number": "601-607-7204",
            "fax_number": "601-607-7430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SAMANTHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-01",
        "last_updated": "2019-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summit, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.