Nicole Samson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

15356 Issued in ND

Practice address

1001 7TH Street NE - Altru Clinic/Devils Lake
Devils Lake, ND 58301-2719

Phone

(701) 662-2157

Fax

(701) 780-4391

NPI assigned

Jun 7, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ND

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

Specialty

Family Practice

Education

University of North Dakota School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Altru Health SystemGroup PAC ID 1355251604, 675 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hia Hospice Hospice, Fargo, ND, CCN 351500
• Altru Hospital Hospital, Grand Forks, ND, CCN 350019
• CHI St Alexius Health Devils Lake Hospital, Devils Lake, ND, CCN 351333
• Eventide Heartland Nursing home, Devils Lake, ND, CCN 355069

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nsamsonstudent66650@direct.directaltru.org

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Lake Region Lutheran Home, Inc.

  • Nursing Facility/Intermediate Care Facility
  • Devils Lake, ND
  • NPI 1689667834

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

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.

• Altru Health System

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1043309552

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Altru Health System

  • Ambulance
  • Grand Forks, ND
  • NPI 1114485315
  NPD
• Lake Region Lutheran Home, Inc.

  • Nursing Facility/Intermediate Care Facility
  • Devils Lake, ND
  • NPI 1689667834
  NPD (past)
• Mercy Hospital of Devils Lake

  • Critical Access Hospital
  • Devils Lake, ND
  • NPI 1659343093
  NPD (past)

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

• Altru Health System

  • General Acute Care Hospital
  • Grand Forks, ND
  • NPI 1154346161
  Care Compare affiliation
• Hospice of the Red River Valley

  • Community Based Hospice Care Agency
  • Fargo, ND
  • NPI 1538253646
  Care Compare affiliation
• Lake Region Lutheran Home, Inc.

  • Nursing Facility/Intermediate Care Facility
  • Devils Lake, ND
  • NPI 1689667834

  Nursing home

  Care Compare affiliation
• Mercy Hospital of Devils Lake

  • Critical Access Hospital
  • Devils Lake, ND
  • NPI 1659343093
  Care Compare affiliation

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1134578537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-1891",
            "fax_number": "701-780-4391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 7TH STREET NE - ALTRU CLINIC/DEVILS LAKE",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012719",
            "telephone_number": "701-662-2157",
            "fax_number": "701-780-4391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMSON",
        "first_name": "NICOLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-07",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "RL14150",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "15356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nsamsonstudent66650@direct.directaltru.org",
            "affiliation": "N",
            "endpointDescription": "Direct Mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1001 7th Street NE - Altru Clinic/Devils Lake",
            "city": "Devils Lake",
            "state": "ND",
            "country_code": "US",
            "postal_code": "583012719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ashley Roulette, CCHW, PPSS, LTA
• Lori Russell, QSP
• Briana Ryba
• Carl Sad, DC
• Jessica Salinas
• Jose Luis Sanchez
• Janice Ann Sandberg
• Amanda J Sandbergwieser, MHT
• Destiney Sandvik
• Paul David Sanford

• Family Medicine Physician in Devils Lake, ND
• Providers in Devils Lake, ND by specialty
• Family Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.