Individual provider Active NPI

Samantha Neeson

  • Family Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1679177299
Registry record updated Oct 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP026138 Issued in PA
Practice address
3400 Civic Center Blvd
Philadelphia, PA 19104-5127
Phone
(215) 615-0063
Fax
(215) 349-8144
NPI assigned
Nov 24, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP026138 PA Primary

Addresses

Primary practice location

3400 Civic Center Blvd
Philadelphia, PA 19104-5127

Mailing address

3400 Civic Center Blvd
Philadelphia, PA 19104-5127
Phone (215) 615-0063

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, PA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210602003194 MA Practitioner - Nurse Practitioner 4082013511 Reassigns benefits to 1 organization
I20221010001279 PA Practitioner - Nurse Practitioner 4082013511 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

330 Brookline Ave
Boston, MA 02215-5400
Phone (617) 754-8612

Hospital & facility affiliations

  • Beth Israel Deaconess Medical Center Hospital, Boston, MA, CCN 220086
  • Beth Israel Deaconess Hospital - Needham Hospital, Needham, MA, CCN 220083
  • Winchester Hospital Hospital, Winchester, MA, CCN 220105
  • Beth Israel Deaconess Hospital - Milton Hospital, Milton, MA, CCN 220108
  • Beth Israel Deaconess Hospital Plymouth Hospital, Plymouth, MA, CCN 220060

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP026138PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Oct 25, 2022 Accepting new patients
University of Penn-Medical Group CurrentSince Oct 25, 2022 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Apr 15, 2021 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Apr 15, 2021 Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

3400 Convention Ave
Philadelphia, PA 19104
Phone (215) 662-2300

3400 Civic Center Blvd
#2
Philadelphia, PA 19104
Phone (215) 615-0063

3400 Civic Center Blvd
Fl 2
Philadelphia, PA 19104

Interoperability endpoints

  • Direct secure messaging: sneeson254765@direct.bilh.masshiway.net

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1606176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1679177299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-615-0063",
            "fax_number": "215-349-8144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-615-0063",
            "fax_number": "215-349-8144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEESON",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-24",
        "last_updated": "2022-10-28",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP026138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.