NPIMap

Individual provider Active NPI

Samuel C Lofton III, PA-C

  • Medical Physician Assistant
  • Lorain, OH
National Provider Identifier
1194729749
Registry record updated Jan 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1059451 Issued in OH
Practice address
4804 Leavitt Rd
Lorain, OH 44053-2139
Phone
(440) 324-5588
Fax
(440) 324-2075
NPI assigned
Jun 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1059451 OH Primary

Addresses

Primary practice location

4804 Leavitt Rd
Lorain, OH 44053-2139

Mailing address

4804 Leavitt Rd
Lorain, OH 44053-2139
Phone (440) 324-5588

Other identifiers 3

IdentifierTypeStateIssuer
P00050528OtherOHRAILROAD MEDICARE
128429100OtherOHFEDERAL WORKERS COMP
000000324024OtherOHANTHEM

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
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1059451OHMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System, Inc Past Accepting new patients
Lake Hospital System, Inc Past Accepting new patients
Comprehensive Pain Care Center, Inc Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390867200000",
    "number": "1194729749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4804 LEAVITT RD",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440532139",
            "telephone_number": "440-324-5588",
            "fax_number": "440-324-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4804 LEAVITT RD",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440532139",
            "telephone_number": "440-324-5588",
            "fax_number": "440-324-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOFTON",
        "first_name": "SAMUEL",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2014-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "1059451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00050528",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL WORKERS COMP",
            "identifier": "128429100",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000324024",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lorain, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.