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SHANE SAMUEL
NPI 1558112565
Nurse Practitioner - Psychiatric/Mental Health in Mesa, AZ

Active since March 28, 2024PECOS EnrolledAccepts Medicare Assignment
10512 E NICHOLS AVE., MESA, AZ 85209(951) 217-9678 Get Directions Write a Review

NPPES record last updated: July 12, 2024. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Jul 12, 2024, Jun 9, 2024 (2 updates tracked since 2024).

About Shane Samuel NPPES

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

SHANE SAMUEL (NPI 1558112565) is an individual psychiatric/mental health provider in Mesa, Arizona, licensed in Arizona (308310) and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1558112565
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameSHANE SAMUEL
Location Address10512 E NICHOLS AVE.Mesa, AZ 85209
Mailing Address10512 E Nichols Ave.Mesa, AZ 85209 · (951) 217-9678
Phone(951) 217-9678
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateMarch 28, 2024
Last NPPES UpdateJuly 12, 20242 updates tracked since enumeration
NPPES CertifiedJuly 12, 2024
✔ NPI 1558112565 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in AZ · 308310
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
10512 E NICHOLS AVE., Mesa, AZ 85209
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health Plan, Inc., Oscar Insurance Company, Providence Health Plan and more.Insurance ›

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

Shane Samuel 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 ID4688114218
PECOS Enrollment IDI20240910004075, I20241012000157
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 85209 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
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$98.00 typical visit price
range $17.72 – $137.41
Typical copayment $24.50 (range $4.43 – $34.35)
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.

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 Shane Samuel's NPI number?

The NPI number for Shane Samuel is 1558112565. It was assigned to this individual provider in the NPPES registry on March 28, 2024.

Where is Shane Samuel located?

Shane Samuel practices at 10512 E Nichols Ave., Mesa, AZ 85209. The listed phone number is (951) 217-9678.

What is Shane Samuel's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Shane Samuel enrolled in Medicare?

Yes. Shane Samuel 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.

What insurance does Shane Samuel accept?

Health plans from Oscar Health Plan, Inc., Oscar Insurance Company, Providence Health Plan and UnitedHealthcare list Shane Samuel 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 Shane Samuel was last updated on July 12, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.