Samantha Pedersen, RN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP61453730 Issued in WA

Practice address

336 Chardonnay Ave Ste a
Prosser, WA 99350-9515

Phone

(509) 786-1576

NPI assigned

May 19, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

Practice roles

Locations

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.

• Prosser Public Hospital District of Benton County

  • Critical Access Hospital
  • Prosser, WA
  • NPI 1306897681
  Medicare reassignment NPD
• Prosser Public Hospital District of Benton County

  • Rural Health Clinic/Center
  • Prosser, WA
  • NPI 1477088391
  NPD
• Prosser Public Hospital District of Benton County

  • Specialist
  • Walla Walla, WA
  • NPI 1518770155
  NPD
• Prosser Public Hospital District of Benton County

  • Gastroenterology Physician
  • Prosser, WA
  • NPI 1780495978
  NPD (past)

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

{
    "created_epoch": "1684454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1871284737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 CHARDONNAY AVE",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "993509515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 CHARDONNAY AVE STE A",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "993509515",
            "telephone_number": "509-786-1576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "SAMANTHA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-19",
        "last_updated": "2023-06-15",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61453730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bailey Faye Padilla, CNM
• Jennifer H Paras, LMHC
• Robin Sue Parks, MS, CCC-SLP
• Benjamin J Passey
• Mollie Pearson, LMP
• Zoraida Perez, L.M.T.
• Pinnacle Sleep and Wake Disorders Center PLLC
• Pinnacle Sleep and Wake Disorders Center,PLLC
• Griselda Ponce-Bucio
• Prosser Chiropractic and Wellness PLLC

• Nurse Practitioner in Prosser, WA
• Providers in Prosser, WA by specialty
• Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.