Active NPI
Samantha Gollup, RD
- Registered Dietitian
- Madison, WI
National Provider Identifier
1881063584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2908-29
- Practice address
- 600 Highland Ave
Madison, WI 53792-2002 - Phone
- (608) 890-5500
- NPI assigned
- Sep 23, 2015
- Last updated
- Nov 18, 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2908-29 | WI | Primary |
Addresses
Primary practice location
600 Highland Ave
Madison, WI 53792-2002
Mailing address
7974 Uw Health CT
Middleton, WI 53562-5531
Other practice location 1
4602 Eastpark Blvd
Madison, WI 53718-2002
Phone (608) 669-0424
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2908-29 | WI | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innate Living Inc | Dietitian, Registered | Past | Accepting new patients |
| Regenerative Nutrition LLC | Dietitian, Registered | Past | Accepting new patients |
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": "1442966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1881063584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7974 UW HEALTH CT",
"city": "MIDDLETON",
"state": "WI",
"postal_code": "535625531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 HIGHLAND AVE",
"city": "MADISON",
"state": "WI",
"postal_code": "537922002",
"telephone_number": "608-890-5500"
}
],
"practiceLocations": [
{
"address_1": "4602 Eastpark Blvd",
"address_purpose": "LOCATION",
"city": "Madison",
"state": "WI",
"postal_code": "537182002",
"country_code": "US",
"telephone_number": "608-669-0424",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GOLLUP",
"first_name": "SAMANTHA",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-23",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WI",
"license": "2908-29",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.