SAMANTHA PRUITT (PMHNP-BC, FNP-BC) – Nurse Practitioner, NPI 1053876391
Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SAMANTHA PRUITT (PMHNP-BC, FNP-BC)
221, Technology Parkway, Berryhill, Rome, Floyd County, Georgia, 30165, United States
ROME, GA 301651369
Phone: (762) 235-1000
Type: Mailing
550, Redmond Road, Mount Berry, Rome, Floyd County, Georgia, 30165, United States
ROME, GA 301651416
Phone: (762) 235-3400
Fax: (706) 233-8507
Type: Location
25 LIBERTY DR UNIT 52
CARTERSVILLE, GA 301202200
Phone: (706) 676-1360
Type: Mailing
3440 BLUE SPRINGS RD NW
STE 503
KENNESAW, GA 301441038
Phone: (404) 423-7063
Type: Location
228 CREEKSTONE RDG
WOODSTOCK, GA 301883732
Phone: (404) 421-2089
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $166.
Total Amount is formed as General ($166) + Research ($0) + Ownership ($0) = $166.
Last reported payment date: 2023-11-16 • Largest payer in this snapshot: Alkermes, Inc. ($140).
Total Amount
$166
General + Research + Ownership
Payments
3
Total payment records
General Amount
$166
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-11-16
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Alkermes, Inc. | $140 |
| Braeburn Inc. | $25 |
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: 2019-03-21
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 |
|---|---|---|---|---|
| I20190321003089 | I | Nurse Practitioner | GA | 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 30165)
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Reviews
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