SAMANTHA ELIZABETH BROCK
NPI 1609601699
Nurse Practitioner - Family in Bolivar, TN

Q: What is Samantha Brock's NPI number?

The NPI number for Samantha Brock is 1609601699. It was assigned to this individual provider in the NPPES registry on September 7, 2024.

Q: What is Samantha Brock'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 Brock was last updated on July 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since September 07, 2024PECOS Enrolled

629 NUCKOLLS RD, BOLIVAR, TN 38008(731) 658-3388 Get Directions Write a Review

NPPES record last updated: July 24, 2026. Verified against the NPPES registry weekly; last sync: October 11, 2026.

Record update history: Jul 24, 2026, Oct 7, 2024, Sep 7, 2024 (3 updates tracked since 2024).

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About Samantha Elizabeth Brock NPPES

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

SAMANTHA ELIZABETH BROCK (NPI 1609601699) is an individual family provider in Bolivar, Tennessee, licensed in Tennessee (42277) and active in the NPI registry since September 2024. She is enrolled in Medicare PECOS and maintains 4 additional practice locations.

NPPES Registry Identity

NPI1609601699

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameSAMANTHA ELIZABETH BROCK

Location Address629 NUCKOLLS RDBolivar, TN 38008-1599

Mailing Address629 Nuckolls RdBolivar, TN 38008-1599 · (731) 658-3388

Phone(731) 658-3388

Sole ProprietorNo

Enumeration DateSeptember 7, 2024

Last NPPES UpdateJuly 24, 20263 updates tracked since enumeration

NPPES CertifiedJuly 24, 2026

✔ NPI 1609601699 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 TN · 42277

629 NUCKOLLS RD, Bolivar, TN 38008

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Secondary Practice Locations 4

Location 1445 Nuckolls RdBolivar, TN 38008-1539 · Phone (731) 658-2902

Location 21132 Industrial DrHenderson, TN 38340-1310 · Phone (731) 983-3175

Location 3627 Nuckolls RoadBolivar, TN 38008 · Phone (731) 600-1063

Location 417 1st St EStanton, TN 38069-4426 · Phone (731) 548-2232

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samantha Elizabeth Brock 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 38008 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

$81.53 typical visit price

range $52.64 – $160.89

Typical copayment $20.38 (range $13.16 – $40.22)

Most-billed visit code 99203

Established Patient

$93.60 typical visit price

range $16.72 – $131.41

Typical copayment $23.40 (range $4.18 – $32.85)

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 19

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

MS. JEANNIE A FERRI FNP

Nurse Practitioner (Family)