Individual provider Active NPI

Samantha Marie Beckwith, DC

  • Chiropractor
  • Niles, MI
National Provider Identifier
1821624552
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301010933 Issued in MI
Practice address
109 S Lincoln Ave
Niles, MI 49120-2917
Phone
(269) 684-7822
Fax
(269) 684-7088
NPI assigned
Mar 13, 2020
Last updated
Sep 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301010933 MI Primary

Addresses

Primary practice location

109 S Lincoln Ave
Niles, MI 49120-2917

Mailing address

109 S Lincoln Ave
Niles, MI 49120-2917
Phone (269) 684-7288

Other identifiers 1

IdentifierTypeStateIssuer
2301010933OtherMISTATE LICENSE

Other names 1

  • Dr. Samantha Marie Gerard Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200401000604 MI Practitioner - Chiropractic 5294164901 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

109 S Lincoln Ave
Niles, MI 49120-2917

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2301010933MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Pure Motion Chiropractic PLLC Chiropractor CurrentSince Feb 21, 2022 Accepting new patients
Thompson Family Chiropractic and Wellness Center P.C. Chiropractor CurrentSince Feb 8, 2023 Accepting new patients

Locations

109 S Lincoln Ave
Niles, MI 49120
Phone (269) 684-7288

25 N 2nd St
Niles, MI 49120
Phone (269) 684-7822

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1821624552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 S LINCOLN AVE",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202917",
            "telephone_number": "269-684-7288",
            "fax_number": "269-684-7022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S LINCOLN AVE",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202917",
            "telephone_number": "269-684-7822",
            "fax_number": "269-684-7088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BECKWITH",
        "first_name": "SAMANTHA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-13",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301010933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2301010933",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "GERARD",
            "middle_name": "MARIE",
            "prefix": "DR.",
            "credential": "DC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Niles, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.