SAMANTHA ELLEDGE (MSN, AGPCNP) – Primary Care Nurse Practitioner, NPI 1285378349

SAMANTHA ELLEDGE (MSN, AGPCNP) is a healthcare provider. based in Troy, Missouri. specializing in NURSE PRACTITIONER. They hold the professional credentials MSN, AGPCNP. They hold a License No. 2021030042 (MO). The NPI Number for SAMANTHA ELLEDGE (MSN, AGPCNP) is 1285378349

Main info

Female
6 Years Of Experience
Accepts Medicare Assignment
Name
SAMANTHA ELLEDGE (MSN, AGPCNP)
NPI
1285378349
Phone
(636) 528-8551
Address
1000 E CHERRY ST
Enumeration Date
25 April 2022
Last Update Date
25 April 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6365283245
Graduation Year
2020 (6 years ago)
PAC ID
3678953304
Group Practice PAC ID
5193040020
Professional Enrollment ID
I20220712000779
Address ID
MO633791513TR1000XSTXX421
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:4State licenses:1Digital endpointsOther names

7,017 NURSE PRACTITIONER in MO

Provider Addresses for SAMANTHA ELLEDGE (MSN, AGPCNP)

  • 1000 E CHERRY ST

    TROY, MO 633791513

    Phone: (636) 528-8551

    Mailing address matches the actual address.

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: 2022-07-12

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20220712000779INurse PractitionerMOTBD

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.

Verify on CMS Revalidation Lookup Tool

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 63379)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5193040020View full group profile
NameSpecialtyState
Nurse PractitionerMO
Internal Medicine, Pediatric MedicineMO
Emergency MedicineMO
Nurse PractitionerMO
Certified Registered Nurse Anesthetist (Crna)MO
-MO
-MO
Nurse PractitionerMO
Nurse PractitionerMO
Emergency Medicine, Family PracticeMO

Reviews

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Frequently asked questions

Is there an official ID for SAMANTHA ELLEDGE (MSN, AGPCNP) in U.S. healthcare records?
The official identifier for SAMANTHA ELLEDGE (MSN, AGPCNP) is NPI 1285378349.
Is SAMANTHA ELLEDGE (MSN, AGPCNP) still an active registrant?
SAMANTHA ELLEDGE (MSN, AGPCNP) carries an active NPI according to the public dataset.
What area of care is associated with SAMANTHA ELLEDGE (MSN, AGPCNP)?
SAMANTHA ELLEDGE (MSN, AGPCNP)'s record emphasizes Primary Care Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where in Missouri is SAMANTHA ELLEDGE (MSN, AGPCNP) registered?
Use Troy, Missouri as the headline location for SAMANTHA ELLEDGE (MSN, AGPCNP) here.
When was this NPI issued?
Enumeration for SAMANTHA ELLEDGE (MSN, AGPCNP) is noted as April 25, 2022 where the registry provides it.

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