SAMANTHA GREGORY DAGENHARDT (RN, MS, MSN, PMHCNS-) – Psychiatric/Mental Health Nurse Practitioner, NPI 1659642841
Psychiatric/Mental Health Nurse Practitioner
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Profile Insights
NPPES metrics only — not quality of care.
6,035 NURSE PRACTITIONER in WI
Provider Addresses for SAMANTHA GREGORY DAGENHARDT (RN, MS, MSN, PMHCNS-)
121 W MAIN ST
PORT WASHINGTON, WI 530741813
Phone: (262) 284-8200
Fax: (262) 284-8103
Type: Mailing
1220 DEWEY AVE
WAUWATOSA, WI 532132504
Phone: (414) 454-6566
Fax: (414) 454-6522
Type: Mailing
1220 Dewey Ave
Wauwatosa, WI 532132504
Phone: (414) 454-6566
Fax: (414) 454-6522
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 6 Open Payments records for all available years, with a total value of $128.
Total Amount is formed as General ($128) + Research ($0) + Ownership ($0) = $128.
Last reported payment date: 2024-12-12 • Largest payer in this snapshot: Alkermes, Inc. ($104).
Total Amount
$128
General + Research + Ownership
Payments
6
Total payment records
General Amount
$128
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-12
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Alkermes, Inc. | $104 |
| Otsuka America Pharmaceutical, Inc. | $24 |
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: 2015-04-07
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 |
|---|---|---|---|---|
| I20150407000155 | I | Nurse Practitioner | WI | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99443 | Telephone medical discussion with physician, 21-30 minutes | 214 | 80 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 138 | 63 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 17 | 12 | $0 |
Insurance plans in this area (ZIP 53074)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | WI | |
| Family Practice | WI | |
| Family Practice | IL | |
| Geriatric Medicine, Internal Medicine | WI | |
| - | WI | |
| - | WI | |
| - | IL | |
| Family Practice | WI | |
| - | OH | |
| - | WI |
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