Samantha Nicole Petty, PMHNP - Medicare Nurse Practitioner in Sterling, IL

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Samantha Nicole Petty, PMHNP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Sterling, Illinois. Her current practice location is 1808 19th Ave, Sterling, Illinois. You can reach out to her office (for appointments etc.) via phone at (815) 718-2344.

Samantha Nicole Petty is licensed to practice in Illinois (license number 209.026134) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1174248405.

Contact Information

Samantha Nicole Petty, PMHNP
1808 19th Ave,
Sterling, IL 61081-1676
(815) 718-2344
Not Available

Map and Direction




Provider's Profile

Full NameSamantha Nicole Petty
GenderFemale
SpecialityNurse Practitioner - Psychiatric/mental Health
Location1808 19th Ave, Sterling, Illinois
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1174248405
  • Provider Enumeration Date: 10/10/2022
  • Last Update Date: 10/10/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 2668845306
  • Enrollment ID: I20230228003214

Medical Identifiers

Medical identifiers for Samantha Nicole Petty such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1174248405NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LP0808XNurse Practitioner - Psychiatric/mental Health 209.026134 (Illinois)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Samantha Nicole Petty allows following entities to bill medicare on her behalf.
Entity NameKsb Medical Group Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1073592119
PECOS PAC ID: 7911890009
Enrollment ID: O20040203000860
Entity NameKatherine Shaw Bethea Hospital
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1427043546
PECOS PAC ID: 2264480037
Enrollment ID: O20081218000029
Entity NameForefront-rosenzweig Medical Services Professional Corporation
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1588101745
PECOS PAC ID: 1052697455
Enrollment ID: O20211124001015

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Samantha Nicole Petty is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Samantha Nicole Petty, PMHNP
1808 19th Ave,
Sterling, IL 61081-1676

Ph: (815) 718-2344		Samantha Nicole Petty, PMHNP
1808 19th Ave,
Sterling, IL 61081-1676

Ph: (815) 718-2344

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.