Individual provider Active NPI

Samuel Charles Speer

  • Diagnostic Radiology Physician
  • Tucson, AZ
National Provider Identifier
1184187486
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
76735 Issued in AZ
Practice address
677 N Wilmot Rd
Tucson, AZ 85711-2701
Phone
(520) 795-2889
NPI assigned
Apr 12, 2019
Last updated
Jun 30, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X 76735 AZ Primary

Addresses

Primary practice location

677 N Wilmot Rd
Tucson, AZ 85711-2701

Mailing address

700 E Morehead St Ste 300
Charlotte, NC 28202-2742

Other practice location 1

500 J Clyde Morris Blvd
Newport News, VA 23601-1929
Phone (757) 594-3945

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20251229003533 OR Practitioner - Diagnostic Radiology 0547684094 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Kansas School of Med (KC/Wich/Sal), 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology LTD LLCGroup PAC ID 6204727589, 107 clinicians

Practice addresses (Care Compare)

Portland, OR 97210-2825
Phone (520) 795-2889

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
76735AZMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology LTD., LLC Diagnostic Radiology CurrentSince Nov 3, 2025 Accepting new patients

Locations

677 N Wilmot Rd
Tucson, AZ 85711
Phone (520) 571-9599

700 E Morehead St
Ste 300
Charlotte, NC 28202
Phone (704) 442-4390

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1555027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1184187486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E MOREHEAD ST STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282022742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 N WILMOT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857112701",
            "telephone_number": "520-795-2889"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 J Clyde Morris Blvd",
            "address_purpose": "LOCATION",
            "city": "Newport News",
            "state": "VA",
            "postal_code": "236011929",
            "country_code": "US",
            "telephone_number": "757-594-3945",
            "fax_number": "757-594-3184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPEER",
        "first_name": "SAMUEL",
        "middle_name": "CHARLES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-12",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AZ",
            "license": "76735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.