MICHELINE SAM (ARNP) – Nurse Practitioner, NPI 1710116454
Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MICHELINE SAM (ARNP)
980 N MICHIGAN AVE STE 1998
CHICAGO, IL 606117504
Phone: (855) 386-2799
Type: Mailing
1825 NW 167TH ST STE 108
MIAMI GARDENS, FL 330564838
Phone: (305) 474-1803
Type: Location
3465 Galt Ocean Dr Ste 101
Ft Lauderdale, FL 333087077
Phone: (954) 566-7775
Type: Location
10225 Ulmerton Rd Ste 1A
Largo, FL 337713522
Phone: (727) 585-7408
Fax: (727) 585-7408
Type: Location
7421 RIDGE RD STE 105
PORT RICHEY, FL 346686935
Phone: (855) 386-2799
Fax: (855) 386-2799
Type: Location
2605, West Atlantic Avenue, Kingsland, Delray Beach, Palm Beach County, Florida, 33445, United States
#D101 LAKE IDA MEDICAL CENTER
DELRAY BEACH, FL 33445
Phone: (561) 279-0991
Fax: (561) 279-0539
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: 2018-05-10
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 |
|---|---|---|---|---|
| I20180510000986 | I | Nurse Practitioner | FL | 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 60611)
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