NPIMap

Individual provider Active NPI

Samantha Mosby, D.O.

  • Family Medicine Physician
  • Eldorado, IL
National Provider Identifier
1609329358
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
T-3253 Issued in MS
Practice address
1306 Maple St
Eldorado, IL 62930-1662
Phone
(618) 273-3361
NPI assigned
Jul 29, 2016
Sex
Female
Sole proprietor
No

Organizations & group practices 9

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ferrell Hospital Community Foundation 58 clinicians

Practice addresses (Care Compare)

1201 Pine St
Eldorado, IL 62930-1634
Phone 61827333611660

1300 US Hwy 45 N
Eldorado, IL 62930-3765
Phone (618) 297-9660

1306 Maple St
Eldorado, IL 62930-1662

Hospital & facility affiliations

  • Hospice of Southern Illinois, Inc Hospice, Belleville, IL, CCN 141504
  • Ferrell Hospital Community Foundations Hospital, Eldorado, IL, CCN 141324
  • Deaconess Hospital Inc Hospital, Evansville, IN, CCN 150082
  • Herrin Hospital Hospital, Herrin, IL, CCN 140011
  • Heartland Regional Medical Center Hospital, Marion, IL, CCN 140184
  • Ferrell Hospital Community Foundations Nursing home, CCN 14Z324

Merit-based Incentive Payment System (MIPS)

Final score
91.05 of 100Reported as apm
Quality
72.1
Promoting interoperability
100
Improvement activities
40

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20221017001811 IL Practitioner - Family Practice 5193054914 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.162061ILMDFamily Medicine Physician
T-3253MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ferrell Hospital Community Foundation Family Medicine CurrentSince Sep 1, 2022 Accepting new patients
Ferrell Hospital Community Foundation Current Accepting new patients
Ferrell Hospital Community Foundation CurrentSince Sep 1, 2022 Accepting new patients
Ferrell Hospital Community Foundation Past Accepting new patients

Locations

1201 Pine St
Ste 112
Eldorado, IL 62930

1306 Maple St
Eldorado, IL 62930
Phone (618) 273-2360

1201 Pine St
Eldorado, IL 62930
Phone (618) 273-3361

250 Small St
Harrisburg, IL 62946
Phone (618) 252-4000

Interoperability endpoints

  • Direct secure messaging: samantha.mosby.1@18357.direct.athenahealth.com
  • Direct secure messaging: smosby233260@direct.deaconess.com

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036.162061 IL
Family Medicine Physician 207Q00000X T-3253 MS Primary

Addresses

NPPES NPI Registry

Primary practice location

1306 Maple St
Eldorado, IL 62930-1662

Mailing address

1201 Pine St Ste 112
Eldorado, IL 62930-1634
Phone (618) 273-3361

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
26678OtherMSMS MEDICAL LICENSURE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 12, 2024.

{
    "created_epoch": "1469750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1609329358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 PINE ST STE 112",
            "city": "ELDORADO",
            "state": "IL",
            "postal_code": "629301634",
            "telephone_number": "618-273-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 MAPLE ST",
            "city": "ELDORADO",
            "state": "IL",
            "postal_code": "629301662",
            "telephone_number": "618-273-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSBY",
        "first_name": "SAMANTHA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-29",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.162061",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "T-3253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MS MEDICAL LICENSURE",
            "identifier": "26678",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldorado, IL

Sources for this page

Verify at the official NPI Registry.