Samuel Ernest Logan, M.D., PHD

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

4301056980 Issued in MI

Practice address

3901 Stonegate Park
Suite 300
Saint Joseph, MI 49085-9137

Phone

(269) 556-6000

Fax

(269) 556-6020

NPI assigned

Jul 1, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

Practice roles

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.

• Lakeland Medical Practices

  • Internal Medicine Physician
  • Saint Joseph, MI
  • NPI 1538397120
  Medicare reassignment
• Prosperity Medical, PLLC

  • Dermatology Physician
  • Saint Joseph, MI
  • NPI 1528837218
  NPD (past)

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1013914241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 STONEGATE PARK",
            "address_2": "SUITE 300",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859137",
            "telephone_number": "269-556-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 STONEGATE PARK",
            "address_2": "SUITE 300",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859137",
            "telephone_number": "269-556-6000",
            "fax_number": "269-556-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "SAMUEL",
        "middle_name": "ERNEST",
        "name_prefix": "Dr.",
        "credential": "M.D., PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MI",
            "license": "4301056980",
            "primary": true
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "MI",
            "license": "4301056980",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301056980",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2663684",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013914241",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luke William Linscheid, FNP-C
• Bo Liu, MD
• Allyssa Jaye Livovich
• Silviu Alexandru Locovei, MD
• Logan Community Resources
• Joseph Longobardi, D.O.
• Danielle Lynn Lorenz, DO
• Chelsia Marie Love, CNM
• Keith Lovell, P.A.
• Jacqueline Veronica Lowe, DNP

• Plastic Surgery Physician in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Plastic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.