Samuel Woldemichael

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LC10486 Issued in MD

Practice address

3415 Hamilton St Ste 9
Hyattsville, MD 20782-3953

Phone

(301) 538-5659

NPI assigned

Jul 29, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Optum Behavioral Care of North Carolina PCGroup PAC ID 5092120030, 175 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Optum Behavioral Care of North Carolina, PC

  • Counseling Psychologist
  • Columbia, MD
  • NPI 1518732833

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Optum Behavioral Care of North Carolina, PC

  • Counseling Psychologist
  • Eldersburg, MD
  • NPI 1306612817

  Single Specialty

  NPD
• Optum Behavioral Care of North Carolina, P.C.

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1861371718

  Single Specialty

  NPD

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

{
    "created_epoch": "1595980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1124637863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8604 NIGHTINGALE DR",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207063953",
            "telephone_number": "301-538-5659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 HAMILTON ST STE 9",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207823953",
            "telephone_number": "301-538-5659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLDEMICHAEL",
        "first_name": "SAMUEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-29",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC10486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerionna Wilson
• Kimberly Wilson, LICSW
• Richard Wilson, O.T.
• Robert H Wilson, MD
• Jeffrey Daniel Winston, D.C.
• Eyob Belay Woldetnsae
• Wondafrash Rehab LLC
• Richard H Wong, D.D.S.
• Darlene Wood
• Sherita Wood, RN

• Professional Counselor in Hyattsville, MD
• Providers in Hyattsville, MD by specialty
• Professional Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; 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.