NPIMap

Individual provider Active NPI

Samuel C White, MD

  • Family Medicine Physician
  • Evansville, WI
National Provider Identifier
1003953704
Registry record updated Nov 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
50076 Issued in WI
Practice address
300 Union St
Evansville, WI 53536-1175
Phone
(608) 882-5613
Fax
(608) 882-6339
NPI assigned
Jan 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 50076 WI Primary

Addresses

Primary practice location

300 Union St
Evansville, WI 53536-1175

Mailing address

300 Union St
Evansville, WI 53536-1175
Phone (608) 882-5613

Other identifiers 1

IdentifierTypeStateIssuer
WHITESAMOtherWIMERCYCARE INSURANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070514000618 WI Practitioner - Family Practice 1456332329 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health System Corporation 749 clinicians

Practice addresses (Care Compare)

300 Union St
Evansville, WI 53536-1175
Phone (608) 882-5613

Hospital & facility affiliations

  • Mercy Health System Corp Hospital, Janesville, WI, CCN 520066

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles (7 of 10)

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation Current Accepting new patients
Mercy Health System Corporation CurrentSince Mar 10, 2011 Accepting new patients
Mercy Health System Corporation CurrentSince Mar 10, 2011 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Mercy Health System Corporation Past Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

300 Union St
Evansville, WI 53536
Phone (608) 882-5613

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

Networks

  • devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
  • IL PPO Downstate
  • IL HMO C-SNP

Organizations & group practices 17

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 17

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320710400000",
    "number": "1003953704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 UNION ST",
            "city": "EVANSVILLE",
            "state": "WI",
            "postal_code": "535361175",
            "telephone_number": "608-882-5613",
            "fax_number": "608-882-6339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 UNION ST",
            "city": "EVANSVILLE",
            "state": "WI",
            "postal_code": "535361175",
            "telephone_number": "608-882-5613",
            "fax_number": "608-882-6339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "SAMUEL",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2011-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "50076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCYCARE INSURANCE",
            "identifier": "WHITESAM",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, WI

Sources for this page

Verify at the official NPI Registry.