MARY T SAMULEVICH APRN
NPI 1013504414
Nurse Practitioner - Family in Springfield, IL

Q: What is Mary Samulevich's NPI number?

The NPI number for Mary Samulevich is 1013504414. It was assigned to this individual provider in the NPPES registry on December 31, 2020.

Q: What is Mary Samulevich's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Mary Samulevich was last updated on December 21, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 31, 2020PECOS EnrolledAccepts Medicare Assignment

2200 WABASH AVE, SPRINGFIELD, IL 62704(217) 528-7541(217) 787-7104 Get Directions Write a Review

NPPES record last updated: December 21, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 21, 2021, Dec 31, 2020 (2 updates tracked since 2020).

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About Mary T Samulevich Aprn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY T SAMULEVICH APRN (NPI 1013504414) is an individual family provider in Springfield, Illinois, licensed in Illinois (209020043) and active in the NPI registry since December 2020. She is enrolled in Medicare PECOS, is affiliated with Memorial Medical Center, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1013504414

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameMARY T SAMULEVICHCredential: APRN

Location Address2200 WABASH AVESpringfield, IL 62704-5352

Mailing Address1025 S 6th StSpringfield, IL 62703-2499 · (217) 528-7541

Phone(217) 528-7541

Fax(217) 787-7104

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateDecember 31, 2020

Last NPPES UpdateDecember 21, 20212 updates tracked since enumeration

NPPES CertifiedDecember 21, 2021

✔ NPI 1013504414 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in IL · 209020043

2200 WABASH AVE, Springfield, IL 62704

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mary T Samulevich Aprn is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2567877897

PECOS Enrollment IDI20210219000930

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

104 services77 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

88 services78 patients

Insertion of needle into vein for collection of blood sample 36415

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

84 services67 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

58 services58 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Memorial Medical Center

Acute Care Hospitals · Springfield, IL

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number140148

Location701 N First StSpringfield, IL 62702 · Sangamon County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62704 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$97.25 typical visit price

range $17.16 – $136.56

Typical copayment $24.31 (range $4.29 – $34.14)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KAITLIN DELANEY HENRY M.D.

Family Medicine