SAMANTHA RAE CARLSON APRN, FNP-BC
NPI 1164316352
Nurse Practitioner - Family in Rockford, IL

Q: What is Samantha Carlson's NPI number?

The NPI number for Samantha Carlson is 1164316352. It was assigned to this individual provider in the NPPES registry on June 4, 2025.

Q: What is Samantha Carlson'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 Samantha Carlson was last updated on October 15, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 04, 2025PECOS EnrolledAccepts Medicare Assignment

5666 E STATE ST, ROCKFORD, IL 61108(815) 226-2000 Get Directions Write a Review

NPPES record last updated: October 15, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Samantha Rae Carlson Aprn, Fnp-bc NPPES

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

SAMANTHA RAE CARLSON APRN, FNP-BC (NPI 1164316352) is an individual family provider in Rockford, Illinois, licensed in Illinois (209031429) and active in the NPI registry since June 2025. She is enrolled in Medicare PECOS, is affiliated with Saint Anthony Medical Center, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1164316352

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameSAMANTHA RAE CARLSONCredential: APRN, FNP-BC

Location Address5666 E STATE STRockford, IL 61108-2425

Mailing Address5666 E State StRockford, IL 61108-2425 · (815) 226-2000

Phone(815) 226-2000

Sole ProprietorNo

Medical School CMSOtherGraduated 2024

Enumeration DateJune 4, 2025

Last NPPES UpdateOctober 15, 2025

NPPES CertifiedOctober 15, 2025

✔ NPI 1164316352 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 · 209031429

5666 E STATE ST, Rockford, IL 61108

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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 Rae Carlson Aprn, Fnp-bc 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 ID1254846587

PECOS Enrollment IDI20250715002640

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.

Hospital Affiliations CMS Care Compare

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

Saint Anthony Medical Center

Acute Care Hospitals · Rockford, IL

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number140233

Location5666 East State StreetRockford, IL 61108 · Winnebago County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61108 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.

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.

DAVID LAIB MD

Pathology (Anatomic Pathology & Clinical Pathology)