Active NPI
Samuel Copeland Gilmore, PA
- Physician Assistant
- Beckley, WV
National Provider Identifier
1164149019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1228984
- Practice address
- 306 Stanaford Rd
Beckley, WV 25801-3142 - Phone
- (304) 255-3000
- NPI assigned
- Oct 21, 2022
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1228984 | VA | Primary |
Addresses
Primary practice location
306 Stanaford Rd
Beckley, WV 25801-3142
Mailing address
1055 Quince Dr
Rockingham, VA 22801-5318
Phone (304) 488-5588
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV, VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1401 Johnston Willis Dr
North Chesterfield, VA 23235-4730
Phone (804) 483-5000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1228984 | VA | MD | Physician Assistant |
Interoperability endpoints
- samuelcgilmore@arh.medalliesdirect.net
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Elkins, WV
- NPI 1093438830
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Beckley, WV
- NPI 1568461440
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737936000000",
"number": "1164149019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 QUINCE DR",
"city": "ROCKINGHAM",
"state": "VA",
"postal_code": "228015318",
"telephone_number": "304-488-5588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 STANAFORD RD",
"city": "BECKLEY",
"state": "WV",
"postal_code": "258013142",
"telephone_number": "304-255-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILMORE",
"first_name": "SAMUEL",
"middle_name": "COPELAND",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-10-21",
"last_updated": "2025-01-27",
"certification_date": "2025-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "1228984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beckley, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.