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SAMANTHA HERNANDEZ
NPI 1811514680
Counselor - Mental Health in Tolleson, AZ

Active since June 28, 2020Opted out of Medicare · through May 6, 2028
2622 S 102ND LN, TOLLESON, AZ 85353(480) 442-7635 Get Directions Write a Review

NPPES record last updated: December 30, 2020. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Dec 30, 2020, Jun 28, 2020 (2 updates tracked since 2020).

About Samantha Hernandez NPPES

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

SAMANTHA HERNANDEZ (NPI 1811514680) is an individual mental health provider in Tolleson, Arizona, licensed in Arizona (18885) and active in the NPI registry since June 2020. She has opted out of Medicare through May 6, 2028.

NPPES Registry Identity

NPI1811514680
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameSAMANTHA HERNANDEZ
Location Address2622 S 102ND LNTolleson, AZ 85353-5678
Mailing AddressPo Box 304Tolleson, AZ 85353-0304
Phone(480) 442-7635
Sole ProprietorYes
Enumeration DateJune 28, 2020
Last NPPES UpdateDecember 30, 20202 updates tracked since enumeration
NPPES CertifiedDecember 30, 2020
✔ NPI 1811514680 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in AZ · 18885
2622 S 102ND LN, Tolleson, AZ 85353
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Samantha Hernandez 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 6, 2024 through May 6, 2028.

Opt-Out Effective DateMay 6, 2024
Opt-Out In Effect ThroughMay 6, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES

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

COGNITIVE TRANSFORMATIONZ LLC
Counselor (Mental Health)
2622 S 102ND LN
TOLLESON, AZ 85353
Maricopa County (480) 414-5070

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 Hernandez's NPI number?

The NPI number for Samantha Hernandez is 1811514680. It was assigned to this individual provider in the NPPES registry on June 28, 2020.

Where is Samantha Hernandez located?

Samantha Hernandez practices at 2622 S 102nd Ln, Tolleson, AZ 85353. The listed phone number is (480) 442-7635.

What is Samantha Hernandez's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Samantha Hernandez enrolled in Medicare?

No. Samantha Hernandez has opted out of Medicare through May 6, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Samantha Hernandez was last updated on December 30, 2020. 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.