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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

SAMANTHA ELLEN PEDERSON PA-C
NPI 1033885504
Physician Assistant - Medical in Henderson, NE

Active since August 17, 2021PECOS EnrolledAccepts Medicare Assignment
1621 FRONT ST, HENDERSON, NE 68371(402) 723-4512(402) 723-4520 Get Directions Write a Review

NPPES record last updated: June 30, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 1, 2022, Nov 2, 2021, Aug 17, 2021 (3 updates tracked since 2021).

About Samantha Ellen Pederson Pa-c NPPES

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

SAMANTHA ELLEN PEDERSON PA-C (NPI 1033885504) is an individual medical provider in Henderson, Nebraska, licensed in Nebraska (2565) and active in the NPI registry since August 2021. She is enrolled in Medicare PECOS, is affiliated with Bryan Medical Center, and maintains a secondary practice location in Sutton.

NPPES Registry Identity

NPI1033885504
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameSAMANTHA ELLEN PEDERSONCredential: PA-C
Location Address1621 FRONT STHenderson, NE 68371-8902
Mailing Address1621 Front StHenderson, NE 68371-8902 · (402) 723-4512 · Fax (402) 723-4520
Phone(402) 723-4512
Fax(402) 723-4520
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateAugust 17, 2021
Last NPPES UpdateJune 30, 20263 updates tracked since enumeration
NPPES CertifiedJune 30, 2026
✔ NPI 1033885504 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in NE · 2565
Also ListedFamily MedicineTaxonomy 207Q00000X · License 2565 (NE)
1621 FRONT ST, Henderson, NE 68371
Open in Google Maps ↗

Other Names 1

Former Name (1)Samantha E Boardman

Secondary Practice Location 1

Location 1208 N French AveSutton, NE 68979-2215 · Phone (402) 773-2130 · Fax (402) 773-2139

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Home State Health, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

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

Samantha Ellen Pederson Pa-c 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 ID9133525934
PECOS Enrollment IDI20210902000662
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 9

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.
136 services105 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.
102 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.
72 services55 patients
Advance care planning, first 30 minutes 99497
Advance care planning is a process where you discuss your healthcare preferences with your doctor. This conversation, lasting up to 30 minutes, helps ensure your wishes are respected if you're unable to communicate them in the future. It's about your care, your way.
27 services27 patients
Hemoglobin a1c level 83036
Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.
25 services22 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.
24 services24 patients

Hospital Affiliations CMS Care Compare

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

Bryan Medical Center

Acute Care Hospitals · Lincoln, NE
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number280003
Location1600 South 48th StLincoln, NE 68506 · Lancaster County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 11

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

DR. LINDSEY CATHERINE NELSON DO
Family Medicine
1621 FRONT ST
HENDERSON, NE 68371
York County (402) 723-4512
HENDERSON HEALTH CARE SERVICES, INC.
General Acute Care Hospital (Critical Access)
1621 FRONT ST
HENDERSON, NE 68371
York County (402) 723-4512
DR. CHRISTOPHER A VANDERNECK M.D.
Family Medicine
1621 FRONT ST
HENDERSON, NE 68371
York County (402) 723-4512
CORTNEY VAN DEN BERG
Physician Assistant (Medical)
1621 FRONT ST
HENDERSON, NE 68371
York County (402) 723-4512
MR. JAMES MATTHEW OHRT M.D.
Family Medicine
1621 FRONT ST
HENDERSON, NE 68371
York County (402) 723-4512
ASHLEY FREEMAN RD
Dietitian, Registered
1621 FRONT ST
HENDERSON, NE 68371
York County (402) 723-4512
HENDERSON HEALTH CARE SERVICES, INC.
Nursing Facility/Intermediate Care Facility
1621 FRONT ST
HENDERSON, NE 68371
York County (402) 723-4512
WHITNEY RATHKE D.P.T.
Physical Therapist
1621 FRONT ST
HENDERSON, NE 68371
York County (402) 723-4512

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samantha Pederson's NPI number?

The NPI number for Samantha Pederson is 1033885504. It was assigned to this individual provider in the NPPES registry on August 17, 2021. The provider is also known as Samantha E Boardman.

Where is Samantha Pederson located?

Samantha Pederson practices at 1621 Front St, Henderson, NE 68371. The listed phone number is (402) 723-4512.

What is Samantha Pederson's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Samantha Pederson enrolled in Medicare?

Yes. Samantha Pederson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Samantha Pederson accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and Blue Cross and Blue Shield of Nebraska and 3 other insurers list Samantha Pederson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Samantha Pederson affiliated with any hospitals?

According to CMS data, Samantha Pederson is affiliated with Bryan Medical Center.

When was this NPI record last updated?

The NPPES record for Samantha Pederson was last updated on June 30, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.