Active NPI
Samuel M. Allen II, M.D.
- Family Medicine Physician
- Quitman, MS
National Provider Identifier
1003898412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 06374
- Practice address
- 603 S Archusa Ave
Quitman, MS 39355-2331 - Phone
- (601) 776-2123
- Fax
- (601) 776-6006
- NPI assigned
- Nov 20, 2005
- Last updated
- Nov 6, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 06374 | MS | Primary |
Addresses
Primary practice location
603 S Archusa Ave
Quitman, MS 39355-2331
Mailing address
PO Box 5208
Meridian, MS 39302-5208
Phone (601) 703-4282
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06374 | MS | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chickasawhay Emergency Physicians LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Emergency Medicine Physician
- Quitman, MS
- NPI 1508048489
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383696000000",
"number": "1003898412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5208",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393025208",
"telephone_number": "601-703-4282",
"fax_number": "601-703-4597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "603 S ARCHUSA AVE",
"city": "QUITMAN",
"state": "MS",
"postal_code": "393552331",
"telephone_number": "601-776-2123",
"fax_number": "601-776-6006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "SAMUEL",
"middle_name": "M.",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-20",
"last_updated": "2013-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MS",
"license": "06374",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Quitman, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.