Individual ProviderSamantha KempkiewiczPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1969 W Ogden Ave, Clinic A, Chicago, IL 60612-3765(312) 864-7900PECOS EnrollmentBased on the most recent information from CMS, provider Samantha Kempkiewicz is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1255005211Provider TypeIndividualFull NameKempkiewicz, SamanthaCredentialPA-CGenderFemaleSole ProprietorYesEnumeration Date8/3/2021Last Updated5/22/2023Contact InformationPractice LocationPractice Address1969 W Ogden Ave, Clinic A, Chicago, IL 60612-3765Phone(312) 864-7900Fax(312) 864-9314Mailing LocationMailing Address1969 W. Ogden Ave, Clinic A, Chicago, IL 60612-3765Phone(312) 864-7900Fax(312) 864-9314Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense085.008740IllinoisCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer