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SAMANTHA ANN KETCHUM SLP
NPI 1902666449
Speech-Language Pathologist in Rochester, MN

Active since March 21, 2024
200 1ST ST SW, ROCHESTER, MN 55905(507) 284-2511 Get Directions Write a Review

NPPES record last updated: October 11, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Samantha Ann Ketchum Slp NPPES

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

SAMANTHA ANN KETCHUM SLP (NPI 1902666449) is an individual speech-language pathologist provider in Rochester, Minnesota, licensed in Minnesota (528810) and active in the NPI registry since March 2024.

NPPES Registry Identity

NPI1902666449
Entity TypeIndividualFemale
Primary Taxonomy235Z00000X
Provider Legal NameSAMANTHA ANN KETCHUMCredential: SLP
Location Address200 1ST ST SWRochester, MN 55905-0001
Mailing Address200 1st St SwRochester, MN 55905-0001 · (507) 284-2511
Phone(507) 284-2511
Sole ProprietorNo
Enumeration DateMarch 21, 2024
Last NPPES UpdateOctober 11, 2024
NPPES CertifiedOctober 11, 2024
✔ NPI 1902666449 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpeech-Language PathologistSpeech, Language and Hearing Service Providers
Taxonomy Code235Z00000X
License✔ Licensed in MN · 528810
Definition
The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.
200 1ST ST SW, Rochester, MN 55905
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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 (PECOS)

Samantha Ann Ketchum Slp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

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

Mayo Clinic
Same address
Infectious Disease
200 1ST ST SW
Rochester, MN 55905
  • Reassigned Medicare billing, Minnesota enrollment
  • 6,534 clinicians in this Medicare group
NPI 1114343860 (507) 284-2511

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

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.

EMILY LEASURE MD
Internal Medicine
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
NATHANAEL BAILEY
Pathology (Clinical Pathology/Laboratory Medicine)
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
NICOLE S NIPPER NP
Nurse Practitioner
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
BRANDI D'SOUZA NP
Nurse Practitioner
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
DR. JODI M. MOORE-WEISS OD
Optometrist
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
JENNIFER L KERKVLIET MA
Psychologist
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
EMMANUEL J LUJERO CRNA
Nurse Anesthetist, Certified Registered
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511
JUAN PABLO BRITO CAMPANA M.D
Internal Medicine (Endocrinology, Diabetes & Metabolism)
200 1ST ST SW
ROCHESTER, MN 55905
Olmsted County (507) 284-2511

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 Ketchum's NPI number?

The NPI number for Samantha Ketchum is 1902666449. It was assigned to this individual provider in the NPPES registry on March 21, 2024.

Where is Samantha Ketchum located?

Samantha Ketchum practices at 200 1st St SW, Rochester, MN 55905. The listed phone number is (507) 284-2511.

What is Samantha Ketchum's specialty?

The primary specialty registered for this NPI is Speech-Language Pathologist with taxonomy code 235Z00000X.

Is Samantha Ketchum enrolled in Medicare?

Yes. Samantha Ketchum is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Samantha Ketchum's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samantha Ketchum reassigns Medicare benefits to Mayo Clinic (Rochester, MN). 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 Ketchum'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 Ketchum was last updated on October 11, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.