Active NPI
Samuel Charles Dotson III, M.D.
- Internal Medicine Physician
- Washington, DC
National Provider Identifier
1154411445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 17053
- Practice address
- 650 Pennsylvania Ave SE
Suite 220
Washington, DC 20003-4318 - Phone
- (202) 543-2664
- Fax
- (202) 546-3244
- NPI assigned
- Oct 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 17053 | DC | Primary |
Addresses
Primary practice location
650 Pennsylvania Ave SE
Suite 220
Washington, DC 20003-4318
Mailing address
1013 C St SE
Washington, DC 20003-2136
Phone (202) 547-2309
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0269239000 | Medicaid | DC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17053 | DC | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154411445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1013 C ST SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200032136",
"telephone_number": "202-547-2309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 PENNSYLVANIA AVE SE",
"address_2": "SUITE 220",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200034318",
"telephone_number": "202-543-2664",
"fax_number": "202-546-3244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOTSON",
"first_name": "SAMUEL",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "DC",
"license": "17053",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0269239000",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.