Active NPI
Samantha Ann Marie Bauer, LGPC
- Mental Health Counselor
- Elkton, MD
National Provider Identifier
1902379431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 200 Booth St
Elkton, MD 21921-5657 - Phone
- (410) 996-5104
- NPI assigned
- Jan 8, 2019
- Last updated
- Mar 9, 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
200 Booth St
Elkton, MD 21921-5657
Mailing address
1275B W Pulaski Hwy
Elkton, MD 21921-4719
Phone (443) 370-1804
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LGP10288 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2057 Pulaski Hwy
North East, MD 21901-3744
Phone (443) 877-4044
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jesse Fairchild LLC | Mental Health | Current | Accepting new patients |
Locations
2057 Pulaski Hwy
Ste 4
North East, MD 21901
Phone (443) 877-4044
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, 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": "1546905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583712000000",
"number": "1902379431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1275B W PULASKI HWY",
"city": "ELKTON",
"state": "MD",
"postal_code": "219214719",
"telephone_number": "443-370-1804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 BOOTH ST",
"city": "ELKTON",
"state": "MD",
"postal_code": "219215657",
"telephone_number": "410-996-5104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUER",
"first_name": "SAMANTHA",
"middle_name": "ANN MARIE",
"credential": "LGPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-08",
"last_updated": "2020-03-09",
"certification_date": "2020-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LGP10288",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; 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.
- 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.