Sampson J Blythe III, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2247 Issued in OK

Practice address

312 S Broadway
Cleveland, OK 74020

Phone

(918) 358-3376

Fax

(918) 358-3376

NPI assigned

Mar 29, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Cleveland Chiropractic Clinic Inc

  • Chiropractor
  • Cleveland, OK
  • NPI 1134260961
  NPD (past)

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344297600000",
    "number": "1205956851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 S BROADWAY",
            "city": "CLEVELAND",
            "state": "OK",
            "postal_code": "74020",
            "telephone_number": "918-358-3376",
            "fax_number": "918-358-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 S BROADWAY",
            "city": "CLEVELAND",
            "state": "OK",
            "postal_code": "74020",
            "telephone_number": "918-358-3376",
            "fax_number": "918-358-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLYTHE",
        "first_name": "SAMPSON",
        "middle_name": "J",
        "name_suffix": "III",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2012-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "2247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100829970A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "731237629001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dalton Birkenholz, OTD
• Eddie J Black, D.C.
• Black's Chiropractic Clinic, Inc.
• Linda Blake, M.A., CCC
• Andrea Blevins
• Marilyn Sue Braden
• Marisa Lee Bravo
• John Alexander Brown, RN
• Rhonda Brown
• Amber Dawn Broyles, BA

• Chiropractor in Cleveland, OK
• Providers in Cleveland, OK by specialty
• Chiropractor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.