Individual provider Active NPI

Katherine Lyn Samberg, CNP

  • Internal Medicine Physician
  • Sylvania, OH
National Provider Identifier
1639672009
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
APRN.CNP.022449 Issued in OH
Practice address
5700 Monroe St Unit 207
Sylvania, OH 43560-2735
Phone
(419) 843-8150
Fax
(419) 472-4359
NPI assigned
Mar 13, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X APRN.CNP.022449 OH Primary

Addresses

Primary practice location

5700 Monroe St Unit 207
Sylvania, OH 43560-2735

Mailing address

1 Seagate
Ste 800
Toledo, OH 43604-1558
Phone (567) 585-1918

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ksamberg127401@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20180723001561 OH Practitioner - Nurse Practitioner 4789931783 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

5700 Monroe St
Sylvania, OH 43560-2767
Phone (567) 585-0005

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians Internal Medicine CurrentSince Jun 9, 2018 Accepting new patients
Promedica Central Physicians CurrentSince Jun 9, 2018 Accepting new patients

Locations

5700 Monroe St
Sylvania, OH 43560
Phone (419) 473-6622

5700 Monroe St
Unit 204
Sylvania, OH 43560
Phone (567) 585-0090

5700 Monroe St
Unit 207
Sylvania, OH 43560
Phone (419) 843-8150

1 Seagate
Ste 800
Toledo, OH 43604

1 Seagate
#800
Toledo, OH 43604
Phone (567) 585-1964

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

Interoperability endpoints

  • Direct secure messaging: ksamberg127401@direct.promedica.org

Organizations & group practices 2

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1639672009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SEAGATE",
            "address_2": "STE 800",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041558",
            "telephone_number": "567-585-1918",
            "fax_number": "419-824-7359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 MONROE ST UNIT 207",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602735",
            "telephone_number": "419-843-8150",
            "fax_number": "419-472-4359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMBERG",
        "first_name": "KATHERINE",
        "middle_name": "LYN",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-13",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "APRN.CNP.022449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ksamberg127401@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sylvania, OH

Sources for this page

Verify at the official NPI Registry.