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MS. SAMANTHA CLARK LICSW
NPI 1477214898
Social Worker in Bridgeport, WV

Active since January 07, 2022PECOS EnrolledAccepts Medicare Assignment
120 PROFESSIONAL PL STE 101, BRIDGEPORT, WV 26330(304) 513-3495(800) 734-8498 Get Directions Write a Review

NPPES record last updated: April 9, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Apr 9, 2026, Jul 17, 2023, Jan 7, 2022 (3 updates tracked since 2022).

About Ms. Samantha Clark Licsw NPPES

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

MS. SAMANTHA CLARK LICSW (NPI 1477214898) is an individual social worker in Bridgeport, West Virginia, licensed in West Virginia (DP00946604) and active in the NPI registry since January 2022. She is enrolled in Medicare PECOS, maintains a secondary practice location in Fairmont, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1477214898
Entity TypeIndividualFemale
Primary Taxonomy104100000X
Provider Legal NameMS. SAMANTHA CLARKCredential: LICSW
Location Address120 PROFESSIONAL PL STE 101Bridgeport, WV 26330-4599
Mailing Address1005 White Willow WayMorgantown, WV 26505-6119 · (304) 513-3495 · Fax (800) 734-8498
Phone(304) 513-3495
Fax(800) 734-8498
Sole ProprietorYes
Medical School CMSOtherGraduated 2020
Enumeration DateJanuary 7, 2022
Last NPPES UpdateApril 9, 20263 updates tracked since enumeration
NPPES CertifiedApril 9, 2026
✔ NPI 1477214898 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers
Taxonomy Code104100000X
Licenses✔ Licensed in WV · DP00946604✔ Licensed in PA · 138525
Definition
A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.
120 PROFESSIONAL PL STE 101, Bridgeport, WV 26330
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Secondary Practice Location 1

Location 114 E Grafton Rd Ste CFairmont, WV 26554-4465 · Phone (304) 366-5832

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ms. Samantha Clark Licsw 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 ID1052895810
PECOS Enrollment IDI20260319001128
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.

Medicare Billing Reassignment

Medicare enrollment records show Samantha Clark reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Gr & w, Inc
29 mi
Clinical Neuropsychologist
1005 WHITE WILLOW WAY
Morgantown, WV 26505
  • Reassigned Medicare billing, West Virginia enrollment
  • 134 clinicians in this Medicare group
NPI 1407192024 (304) 460-5123

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

ASHLEY ERIN FIZER MSW, LGSW
Social Worker (Clinical)
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Harrison County (304) 513-3495
JILL NICOLE STRASSER MSN, APRN, FNP-BC
Nurse Practitioner
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Harrison County (304) 460-5123
MRS. CRYSTAL NICOLE PETTREY LGSW
Social Worker
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Harrison County (304) 513-3495
ROSEMARY MASON LGSW
Social Worker
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Harrison County (304) 513-3495
MISTYAZIA BOLYARD
Physician Assistant
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Harrison County (304) 396-8878
MRS. SHIRLEY SIMMONS PA-C
Physician Assistant
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Harrison County (304) 513-3495
TRACI R BODKINS
Social Worker
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Harrison County (304) 369-8878
RONALENE HOLT DELLIGATTI MSW, LGSW
Social Worker (Clinical)
120 PROFESSIONAL PL STE 101
BRIDGEPORT, WV 26330
Harrison County (304) 513-3495

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 Clark's NPI number?

The NPI number for Samantha Clark is 1477214898. It was assigned to this individual provider in the NPPES registry on January 7, 2022.

Where is Samantha Clark located?

Samantha Clark practices at 120 Professional Pl Ste 101, Bridgeport, WV 26330. The listed phone number is (304) 513-3495.

What is Samantha Clark's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Is Samantha Clark enrolled in Medicare?

Yes. Samantha Clark 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.

Which organization bills Medicare for Samantha Clark's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samantha Clark reassigns Medicare benefits to Gr & w, Inc (Morgantown, WV). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samantha Clark's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Samantha Clark accept?

Health plans from CareSource list Samantha Clark 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.

When was this NPI record last updated?

The NPPES record for Samantha Clark was last updated on April 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months 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.