Individual provider Active NPI

Gbeminiyi Olanrewaju Samuel, MD

  • Gastroenterology Physician
  • Troy, OH
National Provider Identifier
1215322664
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
35.141494 Issued in OH
Practice address
3130 N County Road 25a Ste 109
Troy, OH 45373-1337
Phone
(937) 440-9292
Fax
(937) 440-4227
NPI assigned
Apr 2, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 35.141494 OH Primary

Addresses

Primary practice location

3130 N County Road 25a Ste 109
Troy, OH 45373-1337

Mailing address

3130 N County Road 25a Ste 109
Troy, OH 45373-1337
Phone (937) 440-9292

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address gosamuel@premierhealth.com
Direct Messaging Address gsamuel25085@lickingmemorial.medicity.net Licking Memorial Health Professionals

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
I20210809002732 OH Practitioner - Gastroenterology 9830488022 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Partners Physician GroupGroup PAC ID 4183529340, 409 clinicians
Uvpc Specialists, Inc.Group PAC ID 8921022260, 80 clinicians

Practice addresses (Care Compare)

1 Akron General Ave
Akron, OH 44307-2432
Phone (330) 384-5050

3130 N Country Rd
25A Suite 109
Troy, OH 45373-1337
Phone (937) 440-9292

Hospital & facility affiliations

  • Upper Valley Medical Center Hospital, Troy, OH, CCN 360174
  • Miami Valley Hospital Hospital, Dayton, OH, CCN 360051
  • Akron General Medical Center Hospital, Akron, OH, CCN 360027

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy191
Upper gastrointestinal (GI) endoscopy for acid reflux250

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.141494OHMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Partners Physician Group CurrentSince Sep 20, 2022 Accepting new patients
Licking Memorial Professional Corporation CurrentSince Aug 9, 2021 Accepting new patients
Partners Physician Group CurrentSince Sep 20, 2022 Accepting new patients
Licking Memorial Health Professionals Current Accepting new patients
Uvpc Specialists Inc. CurrentSince Aug 30, 2021 Accepting new patients
Uvpc Specialists, Inc. CurrentSince Aug 30, 2021 Accepting new patients
Licking Memorial Professional Corporation CurrentSince Aug 9, 2021 Accepting new patients

Locations

224 W Exchange St
Ste 160
Akron, OH 44302
Phone (330) 344-6505

1 Akron General Ave
Akron, OH 44307
Phone (330) 344-5760

120 McMillen Dr
Newark, OH 43055
Phone (220) 564-4806

1717 W Main St
Apt 203
Newark, OH 43055
Phone (220) 564-2950

1320 W Main St
Newark, OH 43055
Phone (740) 348-4151

3130 N County Road 25A
Ste 212
Troy, OH 45373
Phone (937) 335-0061

3130 N County Road 25A
#109
Troy, OH 45373
Phone (937) 440-9292

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.

Hospital & facility affiliations 3

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": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1215322664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3130 N COUNTY ROAD 25A STE 109",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453731337",
            "telephone_number": "937-440-9292",
            "fax_number": "937-440-4227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3130 N COUNTY ROAD 25A STE 109",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453731337",
            "telephone_number": "937-440-9292",
            "fax_number": "937-440-4227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "GBEMINIYI",
        "middle_name": "OLANREWAJU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-02",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OH",
            "license": "35.141494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gosamuel@premierhealth.com",
            "affiliation": "N",
            "address_1": "3130 N County Road 25A Ste 109",
            "city": "Troy",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453731337",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gsamuel25085@lickingmemorial.medicity.net",
            "affiliation": "Y",
            "affiliationName": "Licking Memorial Health Professionals",
            "address_1": "1320 W Main St",
            "city": "Newark",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430551822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Troy, OH

Sources for this page

Verify at the official NPI Registry.