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SAMANTHA GOUTERMOUT NP
NPI 1114657228
Nurse Practitioner in Fulton, NY

Active since June 13, 2022PECOS EnrolledAccepts Medicare Assignment
522 S 4TH ST, FULTON, NY 13069(315) 592-3930(315) 592-3932 Get Directions Write a Review

NPPES record last updated: March 29, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Samantha Goutermout Np NPPES

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

SAMANTHA GOUTERMOUT NP (NPI 1114657228) is an individual nurse practitioner in Fulton, New York, licensed in New York (717095) and active in the NPI registry since June 2022. She is enrolled in Medicare PECOS, is affiliated with Oswego Hospital, and is a graduate of State University Of Ny Upstate Medical University (2022).

NPPES Registry Identity

NPI1114657228
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameSAMANTHA GOUTERMOUTCredential: NP
Location Address522 S 4TH STFulton, NY 13069-2946
Mailing Address110 W 6th StOswego, NY 13126-2507 · (315) 349-5511 · Fax (315) 349-5921
Phone(315) 592-3930
Fax(315) 592-3932
Sole ProprietorNo
Medical School CMSState University Of Ny Upstate Medical UniversityGraduated 2022
Enumeration DateJune 13, 2022
Last NPPES UpdateMarch 29, 2023
NPPES CertifiedMarch 29, 2023
✔ NPI 1114657228 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in NY · 717095
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
522 S 4TH ST, Fulton, NY 13069
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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

Samantha Goutermout Np 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 ID7618350893
PECOS Enrollment IDI20220822000854
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 2

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.
35 services19 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.
31 services25 patients

Hospital Affiliations CMS Care Compare

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

Oswego Hospital

Acute Care Hospitals · Oswego, NY
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330218
Location110 West Sixth StreetOswego, NY 13126 · Oswego County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 13069 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
$84.93 typical visit price
range $54.87 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$97.08 typical visit price
range $17.54 – $136.14
Typical copayment $24.27 (range $4.38 – $34.03)
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.

Other Providers at the Same Location NPPES 14

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

MARIE E. CASTILLO-ALCASID M.D.
Internal Medicine
522 S 4TH ST, SUITE 500
FULTON, NY 13069
Oswego County (315) 598-4740
KIMBERLY ANNE POWERS LMHC
Counselor (Mental Health)
522 S 4TH ST
FULTON, NY 13069
Oswego County (315) 598-7400
MARIE-JEANNE DESRAVINES M.D.
Family Medicine
522 S 4TH ST, SUITE 500
FULTON, NY 13069
Oswego County (315) 598-4740
KYLIE M. LACEY N.P.
Nurse Practitioner (Family)
522 S 4TH ST, SUITE 500
FULTON, NY 13069
Oswego County (315) 598-4740
M ZAEEM ANSARI, M.D., P.C.
Internal Medicine (Cardiovascular Disease)
522 S 4TH ST, SUITE 1500
FULTON, NY 13069
Oswego County (315) 593-2010
JAYAKUMAR THOTAMBILU, PHYSICIAN, P.C.
Specialist
522 S 4TH ST, SUITE 1300
FULTON, NY 13069
Oswego County (315) 592-4000
SUSAN A. KRZYZAK N.P.
Nurse Practitioner (Family)
522 S 4TH ST, SUITE 500
FULTON, NY 13069
Oswego County (315) 598-4740
DR. ANDREW ROGALL M.D.
Family Medicine
522 S 4TH ST
FULTON, NY 13069
Oswego County (315) 592-3930

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 Goutermout's NPI number?

The NPI number for Samantha Goutermout is 1114657228. It was assigned to this individual provider in the NPPES registry on June 13, 2022.

Where is Samantha Goutermout located?

Samantha Goutermout practices at 522 S 4th St, Fulton, NY 13069. The listed phone number is (315) 592-3930.

What is Samantha Goutermout's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Samantha Goutermout enrolled in Medicare?

Yes. Samantha Goutermout 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.

Is Samantha Goutermout affiliated with any hospitals?

According to CMS data, Samantha Goutermout is affiliated with Oswego Hospital.

When was this NPI record last updated?

The NPPES record for Samantha Goutermout was last updated on March 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.