Individual provider Active NPI

Samantha Lynne Dowell

  • Pediatric Nurse Practitioner
  • Raleigh, NC
National Provider Identifier
1598378937
Registry record updated Feb 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
5013470 Issued in NC
Practice address
3024 New Bern Ave
Raleigh, NC 27610
Phone
(919) 235-6505
NPI assigned
Aug 25, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 5013470 NC Primary

Addresses

Primary practice location

3024 New Bern Ave
Raleigh, NC 27610

Mailing address

PO Box 602195
Charlotte, NC 28260-2195
Phone (877) 498-4490

Other practice location 1

106 Hyannis Dr
Holly Springs, NC 27540-8327
Phone (919) 249-4700

Other practice location 2

204 Medspring Dr
Clayton, NC 27520
Phone (919) 235-6505

Other identifiers 1

IdentifierTypeStateIssuer
1598378937MedicaidNC

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20230324000321 NC Practitioner - Nurse Practitioner 8628442126 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5013470NCMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Specialty Physicians, LLC CurrentSince Jan 30, 2023 Accepting new patients
Wake Specialty Physicians LLC CurrentSince Jan 30, 2023 Accepting new patients
Wake Specialty Physicians, LLC Current Accepting new patients
Holly Springs Pediatrics PastSince Aug 1, 2020 Accepting new patients

Locations

204 Medspring Dr
Clayton, NC 27520
Phone (910) 775-3130

10000 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1300

3024 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-5318

Interoperability endpoints

  • Direct secure messaging: sdowell325695@directhisp.wakemed.org

Organizations & group practices 4

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": "1598313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1598378937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602195",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602195",
            "telephone_number": "877-498-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3024 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27610",
            "telephone_number": "919-235-6505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 Hyannis Dr",
            "address_purpose": "LOCATION",
            "city": "Holly Springs",
            "state": "NC",
            "postal_code": "275408327",
            "country_code": "US",
            "telephone_number": "919-249-4700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "204 Medspring Dr",
            "address_purpose": "LOCATION",
            "city": "Clayton",
            "state": "NC",
            "postal_code": "27520",
            "country_code": "US",
            "telephone_number": "919-235-6505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOWELL",
        "first_name": "SAMANTHA",
        "middle_name": "LYNNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-25",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5013470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598378937",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.