NPIMap

Individual provider Active NPI

Samantha Martin

  • Family Nurse Practitioner
  • Deridder, LA
National Provider Identifier
1699384628
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
214147 Issued in LA
Practice address
501 S Pine St
Deridder, LA 70634-4939
Phone
(337) 463-9890
NPI assigned
Jul 27, 2020
Last updated
Jan 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

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 214147 LA Primary

Addresses

Primary practice location

501 S Pine St
Deridder, LA 70634-4939

Mailing address

501 S Pine St
Deridder, LA 70634-4939
Phone (337) 463-9890

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200812003751 LA Practitioner - Nurse Practitioner 0042636615 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beauregard Family Medical Center, LLCGroup PAC ID 3577709708, 4 clinicians
Concord Medical Group PLLCGroup PAC ID 0446296818, 189 clinicians

Practice addresses (Care Compare)

501 S Pine St
Deridder, LA 70634-4939
Phone (337) 463-9890

600 S Pine St
Deridder, LA 70634-4942
Phone (337) 462-7100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Medical Group PLLC CurrentSince Jan 21, 2023 Accepting new patients
Beauregard Medical and Surgical Center, LLC CurrentSince Aug 1, 2022 Accepting new patients
Beauregard Family Medical Center, LLC CurrentSince Aug 1, 2022 Accepting new patients
South Central Physicians PLLC Family CurrentSince Jan 21, 2023 Accepting new patients
Beauregard Internal Medicine Center, LLC CurrentSince Aug 1, 2022 Accepting new patients
Concord Medical Group of Texas PLLC CurrentSince Jan 21, 2023 Accepting new patients
Great River Orthopedic and Sports Medicine Center, Inc. CurrentSince Jun 26, 2020 Accepting new patients
Beauregard Women's Health Center, LLC CurrentSince Aug 1, 2022 Accepting new patients
Hospital Service District No 2 of Parish of Beauregard State of la Current Accepting new patients
Great River Orthopedic and Sports Medicine Center, Inc. CurrentSince Jun 26, 2020 Accepting new patients
Hospital Service District No 2 of Parish of Beauregard State of la Past Accepting new patients

Locations

206 W 5th St
Deridder, LA 70634
Phone (337) 462-7106

301 S Washington St
Deridder, LA 70634
Phone (337) 460-7688

495 W 8th St
Deridder, LA 70634
Phone (337) 462-2262

501 S Pine St
Deridder, LA 70634
Phone (337) 310-7378

501 S Pine St
#C
Deridder, LA 70634
Phone (337) 463-9890

600 S Pine St
Deridder, LA 70634
Phone (337) 462-7100

165 Beech Springs Rd
Jonesboro, LA 71251
Phone (318) 259-4435

1106 Port Arthur Ter
Leesville, LA 71446
Phone (337) 404-4075

376 Cocoville Rd
Mansura, LA 71350
Phone (318) 542-4821

Interoperability endpoints

  • Direct secure messaging: samantha.martin@beauregard.medalliesdirect.net

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1699384628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S PINE ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706344939",
            "telephone_number": "337-463-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S PINE ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706344939",
            "telephone_number": "337-463-9890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-27",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "214147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deridder, LA

Sources for this page

Verify at the official NPI Registry.