TYKEIA SAMUEL – Family Nurse Practitioner, NPI 1497209043
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,971 NURSE PRACTITIONER in MA
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Provider Addresses for TYKEIA SAMUEL
63, Main Street, Brockton, Plymouth County, Massachusetts, 02301, United States
BROCKTON, MA 023014042
Phone: (508) 559-6699
Fax: (508) 559-5073
Type: Location
50 Boston St
Lynn, MA 019042538
Phone: (781) 342-4191
Type: Location
301 Columbia Rd
Dorchester, MA 021213409
Phone: (617) 237-6838
Type: Location
205 Parkingway
Quincy, MA 02169
Phone: (617) 820-5968
Type: Location
179 QUINCY ST STE 2
BROCKTON, MA 023022966
Phone: (508) 283-3154
Fax: (833) 450-5159
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-02-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170214000471 | I | Nurse Practitioner | MA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 02301)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | KS | |
| Nurse Practitioner | MA | |
| Physician Assistant | CT | |
| Nurse Practitioner | MA | |
| Nurse Practitioner | MA | |
| Internal Medicine, Hospitalist, Infectious Disease | MA | |
| Nurse Practitioner | MA | |
| Nurse Practitioner | MA | |
| Physician Assistant | MA | |
| Nurse Practitioner | MA |
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