Samuel Douglass, DO

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

OC-0433 Issued in ID

Practice address

1055 N Curtis Rd
Boise, ID 83706-1309

Phone

(208) 367-2121

Fax

(706) 596-6720

NPI assigned

Jan 20, 2015

Last updated

Apr 18, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT, OR, ID3 enrollments

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 3

Specialty

Diagnostic Radiology

Education

Rocky Vista University College of Osteopathic Med, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gem State Radiology LLPGroup PAC ID 9335044833, 60 clinicians

Intermountain Medical Imaging LLCGroup PAC ID 7517870918, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
• Saint Alphonsus Medical Center - Nampa Hospital, Nampa, ID, CCN 130013
• St. Alphonsus Medical Center - Baker City Hospital, Baker City, OR, CCN 381315
• Saint Alphonsus Medical Center Ontario Hospital, Ontario, OR, CCN 380052
• St Luke's Regional Medical Center Hospital, Boise, ID, CCN 130006

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sdouglass696423@direct.med.utah.edu

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.

• Gem State Radiology LLP

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1083661508

  OR

  Medicare reassignment Care Compare group NPD
• Intermountain Medical Imaging LLC

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1669423679
  Medicare reassignment Care Compare group NPD
• University of Utah Adult Services

  • General Practice Physician
  • Salt Lake City, UT
  • NPI 1114321981
  Medicare reassignment NPD
• Intermountain Medical Imaging LLC

  • Diagnostic Radiology Physician
  • Meridian, ID
  • NPI 1679520415
  NPD
• University of Utah Adult Services

  dba University of Utah Hospital Radiology Department

  • Diagnostic Radiology Physician
  • Salt Lake City, UT
  • NPI 1598169419
  NPD
• Intermountain Medical Imaging LLC

  • Diagnostic Radiology Physician
  • Eagle, ID
  • NPI 1326247511
  NPD (past)

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

• Saint Alphonsus Medical Center Nampa, Inc.

  • General Acute Care Hospital
  • Nampa, ID
  • NPI 1659371870
  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  dba Saint Alphonsus RMC TVL

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1184155426
  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  dba St Alphonsus Rehabilitation Services

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1457414948
  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  • Psychiatric Hospital Unit
  • Boise, ID
  • NPI 1770687857
  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  • Family Medicine Physician
  • Caldwell, ID
  • NPI 1861676298

  Hospital

  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1992736649
  Care Compare affiliation
• St Lukes Regional Medical Center

  dba Air St Luke's

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  dba St Lukes Meridian Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation
• Saint Alphonsus Medical Center Baker City, Inc

  • Critical Access Hospital
  • Baker City, OR
  • NPI 1386636355
  Care Compare affiliation
• Saint Alphonsus Medical Center- Ontario Inc

  dba Saint Alphonsus Medical Center Ontario

  • General Acute Care Hospital
  • Ontario, OR
  • NPI 1891891792
  Care Compare affiliation

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

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1063801678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 W MAIN ST STE 603",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026070",
            "telephone_number": "208-954-8070",
            "fax_number": "208-954-8073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061309",
            "telephone_number": "208-367-2121",
            "fax_number": "706-596-6720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9040 Fitzsimmons Dr",
            "address_purpose": "LOCATION",
            "city": "Joint Base Lewis McChord",
            "state": "WA",
            "postal_code": "984311000",
            "country_code": "US",
            "telephone_number": "253-968-0369",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 W Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Gordon",
            "state": "GA",
            "postal_code": "309055741",
            "country_code": "US",
            "telephone_number": "706-787-2175",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1304 Fawcett Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984021900",
            "country_code": "US",
            "telephone_number": "253-761-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "SAMUEL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-20",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "OP61322937",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "DO219310",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NE",
            "license": "1539",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "OC-0433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sdouglass696423@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amelia Doty-Jones, LCSW
• Jenny Lee Doty, LCSW
• Margaret Mary Doucette, D.O.
• Selah Rachel Dougherty
• Erin Douglas, PHARMD
• Nicole Elizabeth Douthit, PA-C
• Thomas F Douthit, PA-C
• Twila Rose Dover, P.T.
• Rachel Dovin, BCBA
• Sam Drew Dow, MD

• Diagnostic Radiology Physician in Boise, ID
• Providers in Boise, ID by specialty
• Diagnostic Radiology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; 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.