Individual provider Active NPI

Samantha Macchio Kapperman, OD

  • Optometrist
  • Cleveland, TN
National Provider Identifier
1831799063
Registry record updated Jul 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3638 Issued in TN
Practice address
2020 Keith St NW
Cleveland, TN 37311-1351
Phone
(423) 472-6517
NPI assigned
Oct 27, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3638 TN Primary

Addresses

Primary practice location

2020 Keith St NW
Cleveland, TN 37311-1351

Mailing address

2020 Keith St NW
Cleveland, TN 37311-1351
Phone (423) 472-6517

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241024003213 TN Practitioner - Optometry 2062945355 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Walter F Peterson OD PCGroup PAC ID 6305993452, 3 clinicians

Practice addresses (Care Compare)

2020 Keith St NW
Suite a
Cleveland, TN 37311-1351
Phone (423) 472-6517

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery93

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3638TNMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Walter F Peterson OD PC Optometrist CurrentSince Jul 12, 2024 Accepting new patients

Locations

2020 Keith St NW
Cleveland, TN 37311
Phone (423) 472-6517

2020 Keith St NW
Ste A
Cleveland, TN 37311

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": "1603756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1831799063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 KEITH ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373111351",
            "telephone_number": "423-472-6517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 KEITH ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373111351",
            "telephone_number": "423-472-6517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAPPERMAN",
        "first_name": "SAMANTHA",
        "middle_name": "MACCHIO",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-27",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "3638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, TN

Sources for this page

Verify at the official NPI Registry.