NPIMap

Individual provider Active NPI

Samuel Thomas Dunn Waller, MD

  • Neurological Surgery Physician
  • Anchorage, AK
National Provider Identifier
1053583211
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
XXXXXXXXX Issued in CO
Practice address
301 W Northern Lights Blvd Ste 400
Anchorage, AK 99503-2648
Phone
(907) 563-4810
Fax
(907) 563-4811
NPI assigned
Mar 27, 2008
Last updated
Sep 30, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X XXXXXXXXX CO Primary

Addresses

Primary practice location

301 W Northern Lights Blvd Ste 400
Anchorage, AK 99503-2648

Mailing address

301 W Northern Lights Blvd Ste 400
Anchorage, AK 99503-2648
Phone (907) 563-4810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, AK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150724010579 WI Practitioner - Neurosurgery 8022332881 Reassigns benefits to 1 organization
I20191108002926 AK Practitioner - Neurosurgery 8022332881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Georgetown University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Coastal Neurology and Neurosurgery IncGroup PAC ID 9436303427, 10 clinicians

Practice addresses (Care Compare)

10928 Eagle River Rd
Eagle River, AK 99577-8078
Phone (907) 694-8085

1700 E Bogard Rd
Wasilla, AK 99654-6570
Phone (907) 921-5088

3719 E Meridian Loop
Suite E
Wasilla, AK 99654-7273
Phone (907) 563-4810

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
70.59 of 100Reported as group
Quality
83.37
Promoting interoperability
100
Improvement activities
40
Cost
16.65

Merit-based Incentive Payment System (MIPS)

Final score
79.12 of 100Reported as group
Quality
81.91
Promoting interoperability
100
Improvement activities
40
Cost
40.93

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion314
Laminectomy or laminotomy (partial removal of spine bones)80
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
XXXXXXXXXCOMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Medical Group, Inc. CurrentSince Jul 1, 2015 Accepting new patients
Aspirus Medical Group, Inc. Current Accepting new patients
Coastal Neurology and Neurosurgery, Inc Neurological Surgery CurrentSince Oct 1, 2019 Accepting new patients
Aspirus Medical Group, Inc. CurrentSince Jul 1, 2015 Accepting new patients
Galen Hospital Alaska, Inc. Past Accepting new patients

Locations

301 W Northern Lights Blvd
Ste 400
Anchorage, AK 99503
Phone (907) 563-4810

4100 Lake Otis Pkwy
Ste 320
Anchorage, AK 99508
Phone (907) 562-4142

3719 E Meridian Loop
Ste E
Wasilla, AK 99654
Phone (907) 373-8281

29980 Network Pl
Chicago, IL 60673

425 Pine Ridge Blvd
Ste 300
Wausau, WI 54401
Phone (715) 847-0402

425 Pine Ridge Blvd
Ste 305B
Wausau, WI 54401
Phone (715) 847-2036

4005 Community Center Dr
Weston, WI 54476
Phone (715) 241-5400

Organizations & group practices 6

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.

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1053583211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 W NORTHERN LIGHTS BLVD STE 400",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995032648",
            "telephone_number": "907-563-4810",
            "fax_number": "907-563-4810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W NORTHERN LIGHTS BLVD STE 400",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995032648",
            "telephone_number": "907-563-4810",
            "fax_number": "907-563-4811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "SAMUEL",
        "middle_name": "THOMAS DUNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-27",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CO",
            "license": "XXXXXXXXX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.