Individual provider Active NPI

Samuel P Hunkler, MD

  • Adult Medicine Physician
  • Ellsworth, ME
National Provider Identifier
1124071543
Registry record updated May 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
12815 Issued in ME
Practice address
32 Resort Way
Ellsworth, ME 04605-1717
Phone
(207) 664-7770
Fax
(207) 664-7724
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X 12815 ME Primary

Addresses

Primary practice location

32 Resort Way
Ellsworth, ME 04605-1717

Mailing address

50 Union St
Ellsworth, ME 04605-1534
Phone (207) 664-7770

Other identifiers 1

IdentifierTypeStateIssuer
1255383972MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20150320000772 TX Practitioner - Family Practice 5698701340 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12815MEMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS, PHS, Naihs, Gallup Indian Medical Center CurrentSince Feb 17, 2015 Accepting new patients
DHHS,PHS,Naihs, Gallup Indian Medical Center CurrentSince Feb 17, 2015 Accepting new patients
Harrington Family Health Center PastSince Nov 1, 2007 Accepting new patients

Locations

516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10564/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462492800000",
    "number": "1124071543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 UNION ST",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046051534",
            "telephone_number": "207-664-7770",
            "fax_number": "207-664-7721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 RESORT WAY",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046051717",
            "telephone_number": "207-664-7770",
            "fax_number": "207-664-7724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUNKLER",
        "first_name": "SAMUEL",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2016-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "ME",
            "license": "12815",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255383972",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellsworth, ME

Sources for this page

Verify at the official NPI Registry.