Samantha Olson, LMFT, SAC is a medicare enrolled "Marriage & Family Therapist" provider in Union Grove, Wisconsin. Her current practice location is
4380 67th Dr # 1028, Union Grove, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(262) 397-9122.
Samantha Olson is licensed to practice in Wisconsin (license number 1287-124) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1740786912.
Healthcare Provider's Profile
| Full Name | Samantha Olson |
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| Gender | Female |
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| Speciality | Marriage & Family Therapist |
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| Location | 4380 67th Dr # 1028, Union Grove, Wisconsin |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1740786912
- Provider Enumeration Date: 04/04/2018
- Last Update Date: 12/08/2023
Medicare PECOS Information:
- PECOS PAC ID: 1557809605
- Enrollment ID: I20240820002649
Medical Identifiers
Medical identifiers for Samantha Olson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1740786912 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 106H00000X | Marriage & Family Therapist | 632-228 (Wisconsin) | Secondary |
| 106H00000X | Marriage & Family Therapist | 1287-124 (Wisconsin) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Samantha Olson allows following entities to bill medicare on her behalf.
| Entity Name | American Behavioral Clinics Sc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1144313859
PECOS PAC ID: 7517937964
Enrollment ID: O20040731000040 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Samantha Olson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Samantha Olson, LMFT, SAC
4380 67th Dr # 1028,
Union Grove, WI 53182-9338
Ph: (262) 397-9122 | Samantha Olson, LMFT, SAC
4380 67th Dr # 1028,
Union Grove, WI 53182-9338
Ph: (262) 397-9122 |
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