SAMUEL HARRY VAN RENSBURG (PMHNP-BC) – Psychiatric/Mental Health Nurse Practitioner, NPI 1063067346
Psychiatric/Mental Health Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SAMUEL HARRY VAN RENSBURG (PMHNP-BC)
1841 E RAMONA AVE
SALT LAKE CITY, UT 841083111
Phone: (203) 343-9490
Type: Mailing
440, 500 East, Central City, Salt Lake City, Salt Lake County, Utah, 84102, United States
SALT LAKE CITY, UT 841022705
Phone: (203) 343-9490
Type: Location
186 Providence St
West Warwick, RI 028932508
Phone: (401) 767-4100
Type: Location
1 River St
Wakefield, RI 028793214
Phone: (401) 767-4100
Type: Location
5770 S 1500 W
TAYLORSVILLE, UT 841235216
Phone: (203) 343-9490
Type: Location
5770 S 1500 W BLDG G
SALT LAKE CITY, UT 841235216
Phone: (801) 313-7770
Type: Mailing
450 CLINTON ST
WOONSOCKET, RI 028953207
Phone: (619) 606-3295
Type: Location
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: 2022-08-10
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 |
|---|---|---|---|---|
| I20220810001263 | I | Nurse Practitioner | UT | 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 84108)
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