Shane Timothy Sampson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35063468 Issued in OH

Practice address

1989 Miamisburg Centerville Rd Ste 301
Centerville, OH 45459-3858

Phone

(937) 434-7353

Fax

(937) 438-6569

NPI assigned

Feb 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Family Practice

Education

Indiana University School of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rural Health Care IncorporatedGroup PAC ID 7214849520, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• AdventHealth Palm Coast Hospital, Palm Coast, FL, CCN 100118

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1579/brand/8/csg/141/fhir/r4
• Direct secure messaging: shane.sampson.p1@direct.azahealth.nextgenshare.com
• Direct secure messaging: shane.sampson.1@1579.direct.athenahealth.com

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.

• Rural Health Care Incorporated

  • Federally Qualified Health Center (FQHC)
  • Palatka, FL
  • NPI 1871569061
  Medicare reassignment Care Compare group NPD
• Ormond Medical Arts Family Practice LLC

  • Family Medicine Physician
  • Ormond Beach, FL
  • NPI 1326254962
  Medicare reassignment NPD
• Rural Health Care Incorporated

  • Federally Qualified Health Center (FQHC)
  • Keystone Heights, FL
  • NPI 1073589065

  Family Medicine

  NPD
• Rural Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Daytona Beach, FL
  • NPI 1891227179
  NPD
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

• Memorial Hospital Flagler Inc

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1679678486
  Care Compare affiliation

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551398400000",
    "number": "1023080116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1989 MIAMISBURG CENTERVILLE RD STE 301",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454593858",
            "telephone_number": "937-434-7353",
            "fax_number": "937-438-6569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1989 MIAMISBURG CENTERVILLE RD STE 301",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454593858",
            "telephone_number": "937-434-7353",
            "fax_number": "937-438-6569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPSON",
        "first_name": "SHANE",
        "middle_name": "TIMOTHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2019-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01038529",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35063468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0891343",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caileigh Sailers, LSW
• Mizuki Saito, DMD
• Monica Salisbury, PC
• Nicholas Wade Salupo, DO
• Bethany Anne Salyers, CNP
• Selyne Samuel, M.D.
• Austin James Sandefur
• Navdeep Sandhu, DDS
• Kathryn Anne Sanford, MD
• Edgar R Santillan, M.D.

• Family Medicine Physician in Centerville, OH
• Providers in Centerville, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.