Samantha Shorter Vickrey, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

A004573 Issued in AR

Practice address

3451 Goodman Rd E Ste 115
Southaven, MS 38672

Phone

(662) 890-5555

NPI assigned

Dec 1, 2015

Last updated

Mar 27, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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 MS

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

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Medical Clinic of North Ms IncGroup PAC ID 5294790861, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Home Care and Hospice North Mississippi Home health agency, Batesville, MS, CCN 257114
• Accentcare Home Health of Greenwood Home health agency, Greenwood, MS, CCN 257131
• Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141
• Methodist Healthcare - Olive Branch Hospital Hospital, Olive Branch, MS, CCN 250167
• Baptist Memorial Hospital Hospital, Memphis, TN, CCN 440048

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: svickrey@fmconm-ms.direct.office.nextgen.com

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.

• Family Medical Clinic of North Ms Inc

  • Family Medicine Physician
  • Southaven, MS
  • NPI 1134174154
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Memorial Hospital-Desoto, Inc,

  • General Acute Care Hospital
  • Southaven, MS
  • NPI 1194789818
  Care Compare affiliation
• LHCG Xcviii, LLC

  dba Baptist Home Care & Hospice - North Mississippi

  • Home Health Agency
  • Batesville, MS
  • NPI 1275068959
  Care Compare affiliation
• Methodist Healthcare - Olive Branch Hospital

  • General Acute Care Hospital
  • Olive Branch, MS
  • NPI 1912341439
  Care Compare affiliation
• Sta-Home Health Agency of Greenwood, Inc.

  dba AccentCare Home Health of Greenwood

  • Home Health Agency
  • Greenwood, MS
  • NPI 1235270588
  Care Compare affiliation
• Baptist Memorial Hospital

  • General Acute Care Hospital
  • Memphis, TN
  • NPI 1578527172
  Care Compare affiliation

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

{
    "created_epoch": "1448928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553644800000",
    "number": "1982079000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3451 GOODMAN RD E STE 115",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386729304",
            "telephone_number": "662-890-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3451 GOODMAN RD E STE 115",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "38672",
            "telephone_number": "662-890-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKREY",
        "first_name": "SAMANTHA",
        "middle_name": "SHORTER",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-01",
        "last_updated": "2019-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A004573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Quy Cong Van
• Lauren Nichole Vanderburg
• Michael Henry Vaughan, M.D.
• Kelly Lynn Velasquez, PMHNP
• Deborah Verucchi, CNP
• Alissa M Villarrubia, MS, RD, LD
• Katie Vinson
• Joseph Anthony Visconti, FNP
• Visionworks, Inc. (Visionworks)
• John Edward Voelpel, DO

• Family Nurse Practitioner in Southaven, MS
• Providers in Southaven, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; 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.

Verify at the official NPI Registry.