Individual provider Active NPI

Eric Michael Samuelson, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Omaha, NE
National Provider Identifier
1205050523
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
27772 Issued in NE
Practice address
2725 S 144TH St Ste 212
Omaha, NE 68144-5253
Phone
(402) 637-0800
Fax
(402) 637-0808
NPI assigned
Apr 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 27772 NE
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X 27772 NE Primary

Addresses

Primary practice location

2725 S 144TH St Ste 212
Omaha, NE 68144-5253

Mailing address

2725 S 144TH St Ste 212
Omaha, NE 68144-5253
Phone (402) 637-0800

Other practice location 1

6829 N 72nd St
Suite 7500
Omaha, NE 68122-1723
Phone (402) 717-0820

Other identifiers 1

IdentifierTypeStateIssuer
27772OtherNENEBRASKA LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address onclinic@orthonebraska.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20140725000217 NE Practitioner - Sports MedicinePractitioner - Orthopedic Surgery 1850532623 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Orthopedic Surgery
Education
University of Nebraska College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthowest, LLCGroup PAC ID 8921086893, 109 clinicians

Practice addresses (Care Compare)

2725 S 144TH St
Suite 212
Omaha, NE 68144-5253
Phone (402) 609-3000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27772NEMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthowest LLC Orthopaedic Surgery CurrentSince May 30, 2017 Accepting new patients
Orthowest LLC Orthopaedic Surgery CurrentSince May 30, 2017 Accepting new patients

Locations

800 Mercy Dr
Ste 220
Council Bluffs, IA 51503
Phone (712) 388-2660

3415 S 205th St
Elkhorn, NE 68022
Phone (402) 609-1750

2540 N Healthy Way
Fremont, NE 68025
Phone (402) 721-3133

450 E 23rd St
Fremont, NE 68025
Phone (402) 721-1610

2725 S 144th St
Ste 212
Omaha, NE 68144
Phone (402) 354-4000

2725 S 144th St
Ste 110
Omaha, NE 68144
Phone (402) 637-0400

17701 Manderson St
Omaha, NE 68116

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1205050523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 S 144TH ST STE 212",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681445253",
            "telephone_number": "402-637-0800",
            "fax_number": "402-637-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 S 144TH ST STE 212",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681445253",
            "telephone_number": "402-637-0800",
            "fax_number": "402-637-0808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6829 N 72nd St",
            "address_2": "Suite 7500",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681221723",
            "country_code": "US",
            "telephone_number": "402-717-0820",
            "fax_number": "402-717-6061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "ERIC",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NE",
            "license": "27772",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NE",
            "license": "27772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEBRASKA LICENSE",
            "identifier": "27772",
            "state": "NE"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "onclinic@orthonebraska.cernerdirect.com",
            "affiliation": "N",
            "address_1": "2725 S 144th St Ste 212",
            "city": "Omaha",
            "state": "NE",
            "country_code": "US",
            "postal_code": "681445253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.