Active NPI
Samantha Gayle Yeagy, ATC
- Sports Medicine (Emergency Medicine) Physician
- Fairmount, IN
National Provider Identifier
1760012181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Emergency Medicine) Physician
- License
- 36002191A
- Practice address
- 11700 S E 00 W
Fairmount, IN 46928-9318 - Phone
- (765) 618-3279
- NPI assigned
- Jan 24, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Emergency Medicine) Physician | 207PS0010X | 36002191A | IN | Primary |
Addresses
Primary practice location
11700 S E 00 W
Fairmount, IN 46928-9318
Mailing address
11700 S E 00 W
Fairmount, IN 46928-9318
Phone (765) 618-3279
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
| License | State | Type | Specialty |
|---|---|---|---|
| 36002191A | IN | MD | Sports Medicine (Emergency Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579824000000",
"number": "1760012181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11700 S E 00 W",
"city": "FAIRMOUNT",
"state": "IN",
"postal_code": "469289318",
"telephone_number": "765-618-3279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11700 S E 00 W",
"city": "FAIRMOUNT",
"state": "IN",
"postal_code": "469289318",
"telephone_number": "765-618-3279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YEAGY",
"first_name": "SAMANTHA",
"middle_name": "GAYLE",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-24",
"last_updated": "2020-01-24",
"certification_date": "2020-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "207PS0010X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Sports Medicine",
"state": "IN",
"license": "36002191A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairmount, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.