NPIMap

Individual provider Active NPI

Samantha Pulvermacher

  • Social Worker
  • Crosby, ND
National Provider Identifier
1689082398
Registry record updated Jul 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
4407 Issued in ND
Practice address
200 North Main Street
Crosby, ND 58730
Phone
(701) 965-6521
Fax
(701) 965-6529
NPI assigned
Jul 25, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 4407 ND Primary

Addresses

Primary practice location

200 North Main Street
Crosby, ND 58730

Mailing address

PO Box 9
Crosby, ND 58730-0009
Phone (701) 965-6521

Other identifiers 1

IdentifierTypeStateIssuer
79419MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4407NDMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Divide County Social Services Social Worker Past Accepting new patients

Organizations & group practices 1

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": "1406246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406246400000",
    "number": "1689082398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "CROSBY",
            "state": "ND",
            "postal_code": "587300009",
            "telephone_number": "701-965-6521",
            "fax_number": "701-965-6529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NORTH MAIN STREET",
            "city": "CROSBY",
            "state": "ND",
            "postal_code": "58730",
            "telephone_number": "701-965-6521",
            "fax_number": "701-965-6529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULVERMACHER",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-25",
        "last_updated": "2014-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ND",
            "license": "4407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "79419",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crosby, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.