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Individual provider Active NPI

Sampson Ndikum

  • Family Nurse Practitioner
  • Fort Collins, CO
National Provider Identifier
1073294757
Registry record updated Jul 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0998960 Issued in CO
Practice address
802 W Drake Rd Ste 145
Fort Collins, CO 80526-5567
Phone
(970) 449-5122
NPI assigned
Jul 26, 2023
Last updated
Jul 26, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 0998960 CO Primary

Addresses

Primary practice location

802 W Drake Rd Ste 145
Fort Collins, CO 80526-5567

Mailing address

802 W Drake Rd Ste 145
Fort Collins, CO 80526-5567
Phone (970) 449-5122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20231018000637 CO Practitioner - Nurse Practitioner 0345695854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Colorado Hospitalists Professional LLCGroup PAC ID 8325147507, 85 clinicians

Practice addresses (Care Compare)

1024 S Lemay Ave
Poudre Valley Hospital
Fort Collins, CO 80524-3929
Phone (970) 495-7142

2021 Battlecreek Dr
Unit a
Fort Collins, CO 80528-5120
Phone (970) 231-4008

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.23 of 100Reported as group
Quality
87
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0998960COMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Colorado Hospitalists Professional LLC Multi-Specialty CurrentSince Jan 1, 2024 Accepting new patients

Locations

1024 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 495-7000

802 W Drake Rd
Fort Collins, CO 80526
Phone (970) 226-1947

802 W Drake Rd
Ste 101
Fort Collins, CO 80526
Phone (970) 221-2273

802 W Drake Rd
Ste 145
Fort Collins, CO 80526
Phone (970) 449-5122

Organizations & group practices 1

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1690329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690329600000",
    "number": "1073294757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 W DRAKE RD STE 145",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805265567",
            "telephone_number": "970-449-5122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 W DRAKE RD STE 145",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805265567",
            "telephone_number": "970-449-5122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NDIKUM",
        "first_name": "SAMPSON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-26",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "0998960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.