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DR. SAMANTHA ARCHUSSACHAT KWON PSY.D.
NPI 1861630022
Psychologist - Clinical in Sacramento, CA

Active since January 27, 2009PECOS EnrolledAccepts Medicare Assignment
2008 MORSE AVE, COMMONS BUILDING, SACRAMENTO, CA 95825(916) 973-7502(916) 973-7320 Get Directions Write a Review

NPPES record last updated: February 11, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Samantha Archussachat Kwon Psy.d. NPPES

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

DR. SAMANTHA ARCHUSSACHAT KWON PSY.D. (NPI 1861630022) is an individual clinical provider in Sacramento, California, licensed in California (PSY22089) and active in the NPI registry since January 2009. She is enrolled in Medicare PECOS and is a graduate of Other (2005).

NPPES Registry Identity

NPI1861630022
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameDR. SAMANTHA ARCHUSSACHAT KWONCredential: PSY.D.
Location Address2008 MORSE AVE, COMMONS BUILDINGSacramento, CA 95825-2135
Mailing Address2008 Morse Ave, Commons BuildingSacramento, CA 95825-2135 · (916) 973-7502 · Fax (916) 973-7320
Phone(916) 973-7502
Fax(916) 973-7320
Sole ProprietorYes
Medical School CMSOtherGraduated 2005
Enumeration DateJanuary 27, 2009
Last NPPES UpdateFebruary 11, 2022
✔ NPI 1861630022 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 CA · PSY22089
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.
2008 MORSE AVE, Sacramento, CA 95825
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Samantha Archussachat Kwon Psy.d. 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 ID7012164635
PECOS Enrollment IDI20120904000208
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 Samantha Kwon reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Permanente Medical Group Inc
41 mi
Internal Medicine
7373 WEST LANE
Stockton, CA 95210
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1548343510 (209) 476-2000

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95825 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
$180.85 typical visit price
range $60.44 – $180.85
Typical copayment $45.21 (range $15.11 – $45.21)
Most-billed visit code 99205
Established Patient
$105.95 typical visit price
range $19.88 – $148.15
Typical copayment $26.48 (range $4.97 – $37.03)
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 20

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

DR. LILA QUEEN KIM PHARMD
Pharmacist
2008 MORSE AVE
SACRAMENTO, CA 95825
Sacramento County (916) 973-5300
MR. CHARLES WILLIAM KIDWELL LCSW
Social Worker (Clinical)
2008 MORSE AVE
SACRAMENTO, CA 95825
Sacramento County (916) 973-5300
DR. CHARLOTTE ROSENBERG CLINICAL PSYCHOLOGIS
Psychologist (Clinical)
2008 MORSE AVE
SACRAMENTO, CA 95825
Sacramento County (916) 973-7323
JESSICA J WILLIAMS PSY.D.
Psychologist (Clinical)
2008 MORSE AVE
SACRAMENTO, CA 95825
Sacramento County (916) 973-7488
ERIN MARIE MATZEN LCSW
Social Worker (Clinical)
2008 MORSE AVE
SACRAMENTO, CA 95825
Sacramento County (916) 973-5300
THOMAS WILLIAM BOONE LCSW
Social Worker (Clinical)
2008 MORSE AVE
SACRAMENTO, CA 95825
Sacramento County (916) 973-7815
DIANA PATRICIA BERRUECOS
Social Worker (Clinical)
2008 MORSE AVE
SACRAMENTO, CA 95825
Sacramento County (916) 973-5300
MS. JANELLE MARIE HERNANDEZ RECREATION THERAPIST
Recreation Therapist
2008 MORSE AVE
SACRAMENTO, CA 95825
Sacramento County (916) 973-7480

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 Kwon's NPI number?

The NPI number for Samantha Kwon is 1861630022. It was assigned to this individual provider in the NPPES registry on January 27, 2009.

Where is Samantha Kwon located?

Samantha Kwon practices at 2008 Morse Ave Commons Building, Sacramento, CA 95825. The listed phone number is (916) 973-7502.

What is Samantha Kwon's specialty?

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

Is Samantha Kwon enrolled in Medicare?

Yes. Samantha Kwon 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.

Which organization bills Medicare for Samantha Kwon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samantha Kwon reassigns Medicare benefits to Permanente Medical Group Inc (Stockton, CA). 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 Samantha Kwon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Samantha Kwon was last updated on February 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.