Samuel Bloomsburg
Individual provider Active NPI Surgery Physician · Morris, MN
NPI 1194394502 · NPPES record last updated Jul 30, 2026
Key facts
- NPI
- 1194394502
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- RL17467 (ND)
- Practice address
- 400 E 1St St
Morris, MN 56267-1408 - Phone
- (320) 589-1313
- Fax
- (320) 589-1065
- NPI assigned
- Jun 21, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210914002187 | ND | Order and Referring Only - General Surgery |
9436555620 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RL17467 | ND | MD | Surgery Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | RL17467 | ND | Yes |
Addresses
Primary practice location
400 E 1St St
Morris, MN 56267-1408
Mailing address
400 E 1St St
Morris, MN 56267-1408
Phone (320) 589-1313
Other providers in Morris, MN
- Christine Marie Banta
- Brent Brian Barnstuble
- Bailey Becker
- Benjamin Berdal
- Ashley Joy Berger
- Ricky A Boehm
- Amy Lynn Brandt
- Brian A Brennan
- BST Morris LLC
- Connie Bullock
All providers in Morris, MN · Surgery Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.