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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

SAMUEL THOMAS GONTKOVSKY PSY.D.
NPI 1801954920
Psychologist - Clinical in Chillicothe, OH

Active since December 04, 2006PECOS Enrolled
83.28/100
CMS Quality Rating
455 SHAWNEE LN, CHILLICOTHE, OH 45601(740) 779-4888(740) 779-4898 Get Directions Write a Review

NPPES record last updated: October 1, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 1, 2026, Dec 14, 2022, Jul 21, 2022 and 2 more (5 updates tracked since 2015).

About Samuel Thomas Gontkovsky Psy.d. NPPES

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

SAMUEL THOMAS GONTKOVSKY PSY.D. (NPI 1801954920) is an individual clinical provider in Chillicothe, Ohio, licensed in Ohio (P.7285) and active in the NPI registry since December 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1801954920
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NameSAMUEL THOMAS GONTKOVSKYCredential: PSY.D.
Location Address455 SHAWNEE LNChillicothe, OH 45601-4145
Mailing Address455 Shawnee LnChillicothe, OH 45601-4145 · (740) 779-4888 · Fax (740) 779-4898
Phone(740) 779-4888
Fax(740) 779-4898
Sole ProprietorNo
Enumeration DateDecember 4, 2006
Last NPPES UpdateOctober 1, 20265 updates tracked since enumeration
NPPES CertifiedOctober 1, 2026
✔ NPI 1801954920 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in OH · P.7285
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
455 SHAWNEE LN, Chillicothe, OH 45601
Open in Google Maps ↗

Other Identifiers 1

Medicaid0108112OH

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Antidote Health Plan of Ohio, Inc., CareSource and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel Thomas Gontkovsky Psy.d. 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.

Medicare Billing Reassignment

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

Adena Medical Group LLC
1.8 mi
Family Medicine
272 HOSPITAL RD
Chillicothe, OH 45601
  • Reassigned Medicare billing, Ohio enrollment
  • 763 clinicians in this Medicare group
NPI 1235468083 (740) 779-7500

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

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Psychiatric diagnostic evaluation 90791
A psychiatric diagnostic evaluation is a thorough assessment used to identify any mental health conditions you may have. It involves a detailed discussion about your symptoms, thoughts, feelings and behavior patterns. Your medical history and family's mental health history are also considered.
14 services14 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45601 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
$166.65 typical visit price
range $54.34 – $166.65
Typical copayment $41.66 (range $13.58 – $41.66)
Most-billed visit code 99205
Established Patient
$96.44 typical visit price
range $17.10 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

83.28/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality58.73
Promoting Interoperability100
Improvement Activities40

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.

REBECCA SILVA EKSTRAND DO
Psychiatry & Neurology (Psychiatry)
455 SHAWNEE LN
CHILLICOTHE, OH 45601
Ross County (740) 773-1141
TRESSA PARAVENTI DO
Student in an Organized Health Care Education/Training Program
455 SHAWNEE LN
CHILLICOTHE, OH 45601
Ross County (740) 779-4888
NAFISA ASAD DO
Psychiatry & Neurology (Psychiatry)
455 SHAWNEE LN
CHILLICOTHE, OH 45601
Ross County (740) 779-4888
ANTHONY R VALLERY DO
Psychiatry & Neurology (Psychiatry)
455 SHAWNEE LN
CHILLICOTHE, OH 45601
Ross County (740) 779-4888
CAROLINE JANET STEIN DO
Student in an Organized Health Care Education/Training Program
455 SHAWNEE LN
CHILLICOTHE, OH 45601
Ross County (740) 779-4888
HRUSHIL PATEL MD
Psychiatry & Neurology (Psychiatry)
455 SHAWNEE LN
CHILLICOTHE, OH 45601
Ross County (740) 779-8225
DR. EMMANUEL AKPAN JR. DO
Psychiatry & Neurology (Psychiatry)
455 SHAWNEE LN
CHILLICOTHE, OH 45601
Ross County (740) 779-4888
MRS. JENNIFER M STRICKLAND LISW
Social Worker
455 SHAWNEE LN
CHILLICOTHE, OH 45601
Ross County (740) 779-4888

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 Gontkovsky's NPI number?

The NPI number for Samuel Gontkovsky is 1801954920. It was assigned to this individual provider in the NPPES registry on December 4, 2006.

Where is Samuel Gontkovsky located?

Samuel Gontkovsky practices at 455 Shawnee Ln, Chillicothe, OH 45601. The listed phone number is (740) 779-4888.

What is Samuel Gontkovsky's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Samuel Gontkovsky enrolled in Medicare?

Yes. Samuel Gontkovsky is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Samuel Gontkovsky's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Gontkovsky reassigns Medicare benefits to Adena Medical Group LLC (Chillicothe, OH). 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 Samuel Gontkovsky's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Samuel Gontkovsky accept?

Health plans from Anthem Blue Cross and Blue Shield, Antidote Health Plan of Ohio, Inc., CareSource, Molina Healthcare and UnitedHealthcare list Samuel Gontkovsky 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 Gontkovsky was last updated on October 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 26 days 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.