SAMRA HICKEY
NPI 1972260768
Student in an Organized Health Care Education/Training Program in St Louis Park, MN

Active since November 29, 2021PECOS EnrolledAccepts Medicare Assignment
5354 PARKDALE DR, ST LOUIS PARK, MN 55416(888) 364-5977 Get Directions Write a Review

NPPES record last updated: November 29, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Samra Hickey NPPES

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

SAMRA HICKEY (NPI 1972260768) is an individual student in an organized health care education/training program in St Louis Park, Minnesota and active in the NPI registry since November 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2019).

NPPES Registry Identity

NPI1972260768
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameSAMRA HICKEY
Location Address5354 PARKDALE DRSt Louis Park, MN 55416-1603
Mailing Address11251 Xavier CirBloomington, MN 55437-3143
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateNovember 29, 2021
NPPES CertifiedNovember 19, 2021
NPI 1972260768 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

5354 PARKDALE DR, St Louis Park, MN 55416

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Samra Hickey 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 ID7517301112
PECOS Enrollment IDI20240222002277
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.

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.

Community/Behavioral Health
5354 PARKDALE DR, SUITE 300
ST LOUIS PK, MN 55416
Psychologist
5354 PARKDALE DR, SUITE 300
ST LOUIS PARK, MN 55416
Psychologist (Clinical)
5354 PARKDALE DR, #2
ST LOUIS PARK, MN 55416
Marriage & Family Therapist
5354 PARKDALE DR, SUITE 200
ST LOUIS PARK, MN 55416
Marriage & Family Therapist
5354 PARKDALE DR, SECOND FLOOR
MINNEAPOLIS, MN 55416
Dietitian, Registered
5354 PARKDALE DR
ST LOUIS PARK, MN 55416
Dietitian, Registered
5354 PARKDALE DR
ST LOUIS PARK, MN 55416
Counselor (Professional)
5354 PARKDALE DR, SUITE 200
ST LOUIS PARK, MN 55416

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1972260768, enumerated as an "individual" on November 29, 2021.

The provider is located at 5354 PARKDALE DR ST LOUIS PARK, MN 55416 and the phone number is (888) 364-5977.

Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

The provider might be accepting Accepts: HealthPartners. Please consult your insurance carrier or call the provider to verify.