MR. SAMUEL KOOLHOVEN-MOORE
NPI 1720650286
Counselor - Mental Health in Sarasota, FL
About Mr. Samuel Koolhoven-moore NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. SAMUEL KOOLHOVEN-MOORE (NPI 1720650286) is an individual mental health provider in Sarasota, Florida, licensed in Florida (MH18940) and active in the NPI registry since July 2021. She has opted out of Medicare through May 14, 2028.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Opted out of Medicare
Mr. Samuel Koolhoven-moore has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 14, 2024 through May 14, 2028.
Other Providers at the Same Location NPPES 4
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SARASOTA, FL 34234
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 Samuel Koolhoven-moore's NPI number?
The NPI number for Samuel Koolhoven-moore is 1720650286. It was assigned to this individual provider in the NPPES registry on July 14, 2021.
Where is Samuel Koolhoven-moore located?
Samuel Koolhoven-moore practices at 1750 17th St Ste J2, Sarasota, FL 34234. The listed phone number is (941) 552-2075.
What is Samuel Koolhoven-moore's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Samuel Koolhoven-moore enrolled in Medicare?
No. Samuel Koolhoven-moore has opted out of Medicare through May 14, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.
What insurance does Samuel Koolhoven-moore accept?
Health plans from Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company) and Molina Healthcare list Samuel Koolhoven-moore 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 Samuel Koolhoven-moore was last updated on July 14, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Mr. Samuel Koolhoven-Moore · NPI 1720650286
Mental Health provider in Sarasota, Florida. Individual provider, active in the CMS NPPES registry since July 14, 2021.
## Identity
- **NPI:** 1720650286 (Entity type: Individual)
- **Enumerated:** July 14, 2021
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **State license:** MH18940 (Florida)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1750 17TH ST STE J2, Sarasota, FL 34234-8690
- **Phone:** (941) 552-2075
## Medicare
- **Medicare:** Opted out of Medicare (opt-out affidavit on file, in effect through May 14, 2028); services are provided under private contract
## Record status
- **NPPES last updated:** July 14, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1720650286) · Data from the CMS NPPES public registry.