KEARIESHA NATALEE ADDISON SAMUELS
NPI 1124895958
Nurse Practitioner - Primary Care in Sacramento, CA

Q: What is Keariesha Addison Samuels's NPI number?

The NPI number for Keariesha Addison Samuels is 1124895958. It was assigned to this individual provider in the NPPES registry on December 12, 2023.

Q: What is Keariesha Addison Samuels's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Active since December 12, 2023PECOS Enrolled

77 CADILLAC DR STE 200, SACRAMENTO, CA 95825(916) 569-8484(916) 457-2667 Get Directions Write a Review

NPPES record last updated: August 12, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 12, 2025, Apr 23, 2024, Dec 12, 2023 (3 updates tracked since 2023).

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About Keariesha Natalee Addison Samuels NPPES

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

KEARIESHA NATALEE ADDISON SAMUELS (NPI 1124895958) is an individual primary care provider in Sacramento, California, licensed in California (95029249) and active in the NPI registry since December 2023. She is enrolled in Medicare PECOS and maintains a secondary practice location in Merced.

NPPES Registry Identity

NPI1124895958

Entity TypeIndividualFemale

Primary Taxonomy363LP2300X

Provider Legal NameKEARIESHA NATALEE ADDISON SAMUELS

Location Address77 CADILLAC DR STE 200Sacramento, CA 95825-8337

Mailing Address3375 Sw 173rd WayMiramar, FL 33029-2605 · (786) 267-4646

Phone(916) 569-8484

Fax(916) 457-2667

Sole ProprietorYes

Enumeration DateDecember 12, 2023

Last NPPES UpdateAugust 12, 20253 updates tracked since enumeration

NPPES CertifiedAugust 12, 2025

✔ NPI 1124895958 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

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

Taxonomy Code363LP2300X

License✔ Licensed in CA · 95029249

Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License 11030106 (FL)

77 CADILLAC DR STE 200, Sacramento, CA 95825

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Secondary Practice Location 1

Location 1737 W Childs AveMerced, CA 95341-6805 · Phone (209) 906-2917

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Keariesha Natalee Addison Samuels is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95825 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

$92.61 typical visit price

range $60.44 – $180.85

Typical copayment $23.15 (range $15.11 – $45.21)

Most-billed visit code 99203

Established Patient

$105.95 typical visit price

range $19.88 – $148.15

Typical copayment $26.48 (range $4.97 – $37.03)

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 6

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

MS. TARA LYNN FAVIS NP-C

Nurse Practitioner (Family)