Individual provider Active NPI

Charles Michael Samson, MD

  • Pediatric Gastroenterology Physician
  • Saint Louis, MO
National Provider Identifier
1194932301
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
2011019875 Issued in MO
Practice address
1 Childrens PL
Div Ped Gastro, Hepatology and Nutrition
Saint Louis, MO 63110-1002
Phone
(314) 454-6173
Fax
(844) 231-8912
NPI assigned
May 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2011019875 MO
Pediatric Gastroenterology Physician 2080P0206X 2011019875 MO Primary

Addresses

Primary practice location

1 Childrens PL
Div Ped Gastro, Hepatology and Nutrition
Saint Louis, MO 63110-1002

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 454-6173

Other identifiers 1

IdentifierTypeStateIssuer
204405104MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20110801000715 MO Practitioner - GastroenterologyPractitioner - Pediatric Medicine 2163575895 Reassigns benefits to 1 organization
I20210211001485 IL Practitioner - Pediatric MedicinePractitioner - Gastroenterology 2163575895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Pediatric Medicine
Education
Washington University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

1 Childrens PL
Saint Louis, MO 63110-1002
Phone (314) 273-1006

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2011019875MOMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Jul 1, 2011 Accepting new patients
Washington University Physicians in Illinois, Inc Current Accepting new patients
Washington University CurrentSince Jul 1, 2011 Accepting new patients
Washington University Physicians in Illinois, Inc CurrentSince Nov 1, 2020 Accepting new patients
Washington University Physicians in Illinois, Inc. CurrentSince Nov 1, 2020 Accepting new patients
Washington University Past Accepting new patients

Locations

4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750

5114 Mid America Plz
Ste 3A
Saint Louis, MO 63129
Phone (314) 454-6120

4240 Duncan Ave
Ste 301
Saint Louis, MO 63110

1 Childrens Pl
#8328
Saint Louis, MO 63110

1 Childrens Pl
Saint Louis, MO 63110
Phone (314) 454-2076

1 Childrens Pl
#8116
Saint Louis, MO 63110
Phone (314) 454-6095

1 Childrens Pl
Ste C
Saint Louis, MO 63110
Phone (314) 454-2104

13001 North Outer 40 Rd
Town and Country, MO 63017
Phone (314) 454-3013

Interoperability endpoints

  • Direct secure messaging: csamson176800@direct.carenet.org

Organizations & group practices 6

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": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1194932301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-454-6173",
            "fax_number": "844-231-8912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PL",
            "address_2": "DIV PED GASTRO, HEPATOLOGY AND NUTRITION",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101002",
            "telephone_number": "314-454-6173",
            "fax_number": "844-231-8912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMSON",
        "first_name": "CHARLES",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2011019875",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "MO",
            "license": "2011019875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204405104",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "1 Childrens Pl",
            "address_2": "Div Ped Gastro, Hepatology and Nutrition",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.