Individual provider Active NPI

Walter P. Samora III, MD

  • Pediatric Orthopaedic Surgery Physician
  • Columbus, OH
National Provider Identifier
1194936120
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Orthopaedic Surgery PhysicianTaxonomy code 207XP3100X
License
35094679 Issued in OH
Practice address
405 Butterfly Gardens Dr
Columbus, OH 43215-4985
Phone
(614) 722-2000
NPI assigned
May 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Orthopaedic Surgery Physician 207XP3100X 35094679 OH Primary
Orthopaedic Surgery Physician 207X00000X 35094679 OH

Addresses

Primary practice location

405 Butterfly Gardens Dr
Columbus, OH 43215-4985

Mailing address

700 Childrens Dr
Columbus, OH 43205-2664
Phone (614) 722-2000

Other practice location 1

7901 Diley Rd
Canal Winchester, OH 43110-9612
Phone (614) 722-6200

Other practice location 2

5680 Venture Dr
Dublin, OH 43017-2190
Phone (614) 722-6200

Other practice location 3

6435 E Broad St
Columbus, OH 43213-1507
Phone (614) 722-6200

Other practice location 4

700 Childrens Dr
Columbus, OH 43205-2664
Phone (614) 722-6200

Other practice location 5

536 S Trimble Rd
Mansfield, OH 44906-3418
Phone (614) 722-6200

Other practice location 6

150 W Main St
New Albany, OH 43054-9229
Phone (614) 722-6200

Other practice location 7

584 County Line Rd W
Westerville, OH 43082-7295
Phone (614) 722-6200

Other practice location 8

4363 All Seasons Dr
Hilliard, OH 43026-2050
Phone (614) 722-6200

Other identifiers 1

IdentifierTypeStateIssuer
3060217MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20100819000547 OH Practitioner - Orthopedic Surgery 1850425349 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35094679OHMDPediatric Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nationwide Children'S Hospital CurrentSince Sep 24, 2024 Accepting new patients
Nationwide Children'S Hospital CurrentSince Sep 24, 2024 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Nationwide Children'S Hospital Past Accepting new patients
Children'S Hospital Medical Center of Akron Past Accepting new patients
Children'S Hospital Medical Center of Akron Past Accepting new patients

Locations

Dept 781629
Detroit, MI 48278

7901 Diley Rd
Canal Winchester, OH 43110
Phone (614) 355-9050

700 Childrens Dr
Columbus, OH 43205
Phone (614) 722-4411

479 Parsons Ave
Columbus, OH 43215
Phone (614) 272-8888

6435 E Broad St
Columbus, OH 43213
Phone (614) 355-8100

700 Childrens Dr
Bldg 3
Columbus, OH 43205

405 Butterfly Gardens Dr
Columbus, OH 43215
Phone (614) 722-4200

1 Childrens Plz
Dayton, OH 45404
Phone (937) 641-3600

5680 Venture Dr
Dublin, OH 43017
Phone (614) 355-8700

4363 All Seasons Dr
Hilliard, OH 43026
Phone (614) 355-5900

536 S Trimble Rd
Mansfield, OH 44906
Phone (419) 528-3150

150 W Main St
New Albany, OH 43054
Phone (614) 355-6054

584 County Line Rd W
Westerville, OH 43082
Phone (614) 355-6052

Organizations & group practices 7

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": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1194936120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 CHILDRENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432052664",
            "telephone_number": "614-722-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 BUTTERFLY GARDENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432154985",
            "telephone_number": "614-722-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7901 Diley Rd",
            "address_purpose": "LOCATION",
            "city": "Canal Winchester",
            "state": "OH",
            "postal_code": "431109612",
            "country_code": "US",
            "telephone_number": "614-722-6200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5680 Venture Dr",
            "address_purpose": "LOCATION",
            "city": "Dublin",
            "state": "OH",
            "postal_code": "430172190",
            "country_code": "US",
            "telephone_number": "614-722-6200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6435 E Broad St",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432131507",
            "country_code": "US",
            "telephone_number": "614-722-6200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 Childrens Dr",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432052664",
            "country_code": "US",
            "telephone_number": "614-722-6200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "536 S Trimble Rd",
            "address_purpose": "LOCATION",
            "city": "Mansfield",
            "state": "OH",
            "postal_code": "449063418",
            "country_code": "US",
            "telephone_number": "614-722-6200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "150 W Main St",
            "address_purpose": "LOCATION",
            "city": "New Albany",
            "state": "OH",
            "postal_code": "430549229",
            "country_code": "US",
            "telephone_number": "614-722-6200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "584 County Line Rd W",
            "address_purpose": "LOCATION",
            "city": "Westerville",
            "state": "OH",
            "postal_code": "430827295",
            "country_code": "US",
            "telephone_number": "614-722-6200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4363 All Seasons Dr",
            "address_purpose": "LOCATION",
            "city": "Hilliard",
            "state": "OH",
            "postal_code": "430262050",
            "country_code": "US",
            "telephone_number": "614-722-6200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMORA",
        "first_name": "WALTER",
        "middle_name": "P.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "OH",
            "license": "35094679",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OH",
            "license": "35094679",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3060217",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.