HEATHER SAMUDOVSKY PA-C
NPI 1356962120
Physician Assistant in Springfield, IL

Active since May 02, 2020PECOS Enrolled
800 E CARPENTER ST, SPRINGFIELD, IL 62769(217) 544-6464 Get Directions Write a Review

NPPES record last updated: March 7, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 7, 2024, Feb 5, 2021, Jan 15, 2021 (3 updates tracked since 2021).

About Heather Samudovsky Pa-c NPPES

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

HEATHER SAMUDOVSKY PA-C (NPI 1356962120) is an individual physician assistant in Springfield, Illinois, licensed in Illinois (085-007904) and active in the NPI registry since May 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1356962120
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameHEATHER SAMUDOVSKYCredential: PA-C
Location Address800 E CARPENTER STSpringfield, IL 62769-4902
Mailing Address111 Oakwood RdEast Peoria, IL 61611-1853 · (309) 740-4272
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateMay 2, 2020
Last NPPES UpdateMarch 7, 20243 updates tracked since enumeration
NPPES CertifiedMarch 7, 2024
NPI 1356962120 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in IL · 085-007904
Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

800 E CARPENTER ST, Springfield, IL 62769

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Heather Samudovsky Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID648684647
PECOS Enrollment IDI20210203001349
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 62769 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
$68.64 typical visit price
range $17.16 – $136.56
Typical copayment $17.16 (range $4.29 – $34.14)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
31 suppliers149 claims605 services$5.90 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
11 suppliers34 claims77 services$1.05 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
13 suppliers349 claims349 services$187.30 avg. paid by Medicare
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system K0554
DME-Other DME · category DE017N
7 suppliers24 claims24 services$198.04 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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.

Radiology (Diagnostic Radiology)
800 E CARPENTER ST
SPRINGFIELD, IL 62769
Nurse Anesthetist, Certified Registered
800 E CARPENTER ST
SPRINGFIELD, IL 62769
Internal Medicine (Critical Care Medicine)
800 E CARPENTER ST
SPRINGFIELD, IL 62769
Radiology (Diagnostic Radiology)
800 E CARPENTER ST
SPRINGFIELD, IL 62769
Pathology (Anatomic Pathology & Clinical Pathology)
800 E CARPENTER ST
SPRINGFIELD, IL 62769
Anesthesiology
800 E CARPENTER ST
SPRINGFIELD, IL 62769
Pathology (Anatomic Pathology & Clinical Pathology)
800 E CARPENTER ST
SPRINGFIELD, IL 62769
Occupational Therapist
800 E CARPENTER ST
SPRINGFIELD, IL 62769

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 Heather Samudovsky's NPI number?

The NPI number for Heather Samudovsky is 1356962120. It was assigned to this individual provider in the NPPES registry on May 2, 2020.

Where is Heather Samudovsky located?

Heather Samudovsky practices at 800 E Carpenter St, Springfield, IL 62769. The listed phone number is (217) 544-6464.

What is Heather Samudovsky's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Heather Samudovsky enrolled in Medicare?

Yes. Heather Samudovsky is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Heather Samudovsky was last updated on March 7, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.