Individual provider Active NPI

Samira Sugule, MD

  • Internal Medicine Physician
  • Blaine, MN
National Provider Identifier
1235690611
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
71169 Issued in CT
Practice address
10961 Club West Pkwy
Blaine, MN 55449-5866
Phone
(763) 528-2987
NPI assigned
Mar 27, 2019
Last updated
Oct 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 71169 CT Primary
Hospitalist Physician 208M00000X 71169 CT

Addresses

Primary practice location

10961 Club West Pkwy
Blaine, MN 55449-5866

Mailing address

1700 University Ave W
Saint Paul, MN 55104-3727

Other practice location 1

34 Maple St
Norwalk, CT 06850-3815
Phone (203) 852-2025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, MN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220711003092 CT Practitioner - Internal Medicine 0345620134
I20250902002029 MN Practitioner - Internal Medicine 0345620134 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

10961 Club W Pkwy
Blaine, MN 55449-5866
Phone (763) 572-5700

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71169CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Aug 13, 2025 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Aug 13, 2025 Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

10961 Club West Pkwy
Minneapolis, MN 55449
Phone (763) 572-5700

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760313600000",
    "number": "1235690611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10961 CLUB WEST PKWY",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554495866",
            "telephone_number": "763-528-2987"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34 Maple St",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CT",
            "postal_code": "068503815",
            "country_code": "US",
            "telephone_number": "203-852-2025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUGULE",
        "first_name": "SAMIRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-27",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "71169",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "71169",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

Verify at the official NPI Registry.