Individual provider Active NPI

Samantha Kathryn Jenney, PA-C

  • Physician Assistant
  • Indianapolis, IN
National Provider Identifier
1992220719
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10002333A Issued in IN
Practice address
8040 Clearvista Pkwy Ste 550
Indianapolis, IN 46256-5606
Phone
(317) 621-9470
NPI assigned
Aug 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10002333A IN Primary

Addresses

Primary practice location

8040 Clearvista Pkwy Ste 550
Indianapolis, IN 46256-5606

Mailing address

6626 E 75TH St Ste 500
Indianapolis, IN 46250-2890

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20171102002348 IN Practitioner - Physician Assistant 5193081453 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians
Community Physician Network Specialty Care LLCGroup PAC ID 9931697265, 260 clinicians

Practice addresses (Care Compare)

7120 Clearvista Dr
Suite 4000
Indianapolis, IN 46256-1774
Phone (317) 621-7444

8040 Clearvista Pkwy
Suite 550
Indianapolis, IN 46256-5606
Phone (317) 621-9470

8075 N Shadeland Ave
Indianapolis, IN 46250-2693
Phone (317) 621-8000

Merit-based Incentive Payment System (MIPS)

Final score
78.42 of 100Reported as group
Quality
62.19
Promoting interoperability
99
Improvement activities
40
Cost
61.29

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
7922AZMDPhysical Therapy Assistant
10002333AINMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physician Network Specialty Care LLC CurrentSince Dec 16, 2025 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Dec 9, 2024 Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

5918 Reliable Pkwy
Chicago, IL 60686

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

8040 Clearvista Pkwy
Ste 550
Indianapolis, IN 46256
Phone (317) 621-9470

8075 N Shadeland Ave
Indianapolis, IN 46250
Phone (317) 621-8000

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

Interoperability endpoints

  • Direct secure messaging: ssorg632352@ecommunitydirect.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1502668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1992220719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8040 CLEARVISTA PKWY STE 550",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462565606",
            "telephone_number": "317-621-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNEY",
        "first_name": "SAMANTHA",
        "middle_name": "KATHRYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-14",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10002333A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.