NPIMap

Individual provider Active NPI

Samuel J. King II, M.D.

  • Anesthesiology Physician
  • Fort Wayne, IN
National Provider Identifier
1235314998
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
01075535A Issued in IN
Practice address
6435 W Jefferson Blvd # 434
Fort Wayne, IN 46804-6203
Phone
(260) 436-7875
Fax
(260) 432-9812
NPI assigned
Dec 31, 2007
Last updated
Mar 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 43519 KY
Anesthesiology Physician 207L00000X 57.014040 OH
Anesthesiology Physician 207L00000X 01075535A IN Primary

Addresses

Primary practice location

6435 W Jefferson Blvd # 434
Fort Wayne, IN 46804-6203

Mailing address

PO Box 843603
Dallas, TX 75284-0001
Phone (972) 233-1999

Other practice location 1

911 Bypass Road
Pikeville, KY 41501
Phone (606) 218-3500

Other identifiers 1

IdentifierTypeStateIssuer
7100127110MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100916001108 KY Practitioner - Anesthesiology 6709901598 Reassigns benefits to 3 organizations
I20150918000442 IN Practitioner - Anesthesiology 6709901598 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Louisville School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Anesthesiologists of Fort Wayne PCGroup PAC ID 2264412444, 101 clinicians

Practice addresses (Care Compare)

4023 Reas LN
New Albany, IN 47150-2228
Phone (812) 206-7660

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43519KYMDAnesthesiology Physician
57.014040OHMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Capital Anesthesia Solutions of Kentucky LLC Anesthesiology CurrentSince Jul 14, 2021 Accepting new patients
Ema Anesthesia, PSC Anesthesiology CurrentSince Aug 22, 2016 Accepting new patients
Commonwealth Anesthesia, PSC Anesthesiology CurrentSince Aug 1, 2022 Accepting new patients
Associated Anesthesiologists of Fort Wayne PC Anesthesiology CurrentSince Mar 12, 2025 Accepting new patients
U S Anesthesia Partners of Kentucky PSC Anesthesiology PastSince Sep 1, 2023 Accepting new patients

Locations

1316 E 7th St
Auburn, IN 46706
Phone (260) 925-4600

10315 Dawsons Creek Blvd
Ste Ab
Fort Wayne, IN 46825
Phone (219) 436-7875

6435 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 436-7875

360 Missouri Ave
Ste 102
Jeffersonvlle, IN 47130
Phone (502) 364-0902

2201 Green Valley Rd
New Albany, IN 47150
Phone (812) 949-1223

4023 Reas Ln
New Albany, IN 47150
Phone (502) 690-6425

310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612

4005 DuPont Cir
Louisville, KY 40207
Phone (502) 897-7401

305 Langdon St
Somerset, KY 42503
Phone (606) 451-2994

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1235314998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843603",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752840001",
            "telephone_number": "972-233-1999",
            "fax_number": "972-233-3666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6435 W JEFFERSON BLVD # 434",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046203",
            "telephone_number": "260-436-7875",
            "fax_number": "260-432-9812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 Bypass Road",
            "address_purpose": "LOCATION",
            "city": "Pikeville",
            "state": "KY",
            "postal_code": "41501",
            "country_code": "US",
            "telephone_number": "606-218-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "SAMUEL",
        "middle_name": "J.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-31",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": "43519",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "57.014040",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "01075535A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100127110",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.