Individual provider Active NPI

Samuel Lindsey Hill Jr., NP

  • Nurse Practitioner
  • Greeley, CO
National Provider Identifier
1679295182
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
C-APN.0102503-C-NP Issued in CO
Practice address
1709 61St Ave
Greeley, CO 80634-3044
Phone
(970) 330-0333
NPI assigned
Sep 13, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 905525 MS
Nurse Practitioner 363L00000X C-APN.0102503-C-NP CO Primary

Addresses

Primary practice location

1709 61St Ave
Greeley, CO 80634-3044

Mailing address

632 Sundance Dr
Windsor, CO 80550-3177
Phone (601) 433-1618

Other practice location 1

1203 Jefferson St
Laurel, MS 39440-4354
Phone (601) 649-2863

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20221006001661 MS Practitioner - Nurse Practitioner 2567848039 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C-APN.0102503-C-NPCOMDNurse Practitioner
905525MSMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Central Clinics, Inc CurrentSince Jun 17, 2022 Accepting new patients
South Central Clinics, Inc CurrentSince Jun 17, 2022 Accepting new patients
South Central Clinics, Inc Current Accepting new patients

Locations

1203 B Ave
Ellisville, MS 39437
Phone (601) 477-8553

1203 Jefferson St
Laurel, MS 39440
Phone (601) 579-5488

Organizations & group practices 3

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": "1663027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1679295182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 SUNDANCE DR",
            "city": "WINDSOR",
            "state": "CO",
            "postal_code": "805503177",
            "telephone_number": "601-433-1618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1709 61ST AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806343044",
            "telephone_number": "970-330-0333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1203 Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Laurel",
            "state": "MS",
            "postal_code": "394404354",
            "country_code": "US",
            "telephone_number": "601-649-2863",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HILL",
        "first_name": "SAMUEL",
        "middle_name": "LINDSEY",
        "name_suffix": "Jr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-13",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "905525",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "C-APN.0102503-C-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

Verify at the official NPI Registry.