Samantha Renee Fraley, is a medicare enrolled "Registered Nurse" in Vansant, Virginia. Her current practice location is
18765 Riverside Dr, Vansant, Virginia. You can reach out to her office (for appointments etc.) via phone at
(276) 935-2880.
Samantha Renee Fraley is licensed to practice in Virginia (license number 0001246096) 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 1154133676.
Provider's Profile
| Full Name | Samantha Renee Fraley |
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| Gender | Female |
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| Speciality | Registered Nurse |
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| Location | 18765 Riverside Dr, Vansant, Virginia |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1154133676
- Provider Enumeration Date: 01/22/2025
- Last Update Date: 02/11/2025
Medicare PECOS Information:
- PECOS PAC ID: 1052833704
- Enrollment ID: I20250321002846
Medical Identifiers
Medical identifiers for Samantha Renee Fraley such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1154133676 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | 0024192519 (Virginia) | Secondary |
| 163W00000X | Registered Nurse | 0001246096 (Virginia) | 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 Renee Fraley allows following entities to bill medicare on her behalf.
| Entity Name | Appalachian Family Care, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1053336636
PECOS PAC ID: 9931206232
Enrollment ID: O20070522000190 |
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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 Renee Fraley 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 Address | Practice Location Address |
|---|
Samantha Renee Fraley,
Po Box 144,
Big Rock, VA 24603-0144
Ph: (423) 754-7768 | Samantha Renee Fraley,
18765 Riverside Dr,
Vansant, VA 24656
Ph: (276) 935-2880 |
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