John Wilson Samples, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A66241 Issued in CA

Practice address

72780 Country Club Dr
BLDG B 205-B
Rancho Mirage, CA 92270-4126

Phone

(760) 834-7900

Fax

(760) 834-7901

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Internal Medicine

Education

Loma Linda University School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment Care Compare group NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Fontana, CA
  • NPI 1689606196
  NPD
• Eisenhower Medical Center

  • General Acute Care Hospital
  • Rancho Mirage, CA
  • NPI 1013981554
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1265455935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72780 COUNTRY CLUB DR",
            "address_2": "BLDG B 205-B",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922704126",
            "telephone_number": "760-834-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72780 COUNTRY CLUB DR",
            "address_2": "BLDG B 205-B",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922704126",
            "telephone_number": "760-834-7900",
            "fax_number": "760-834-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPLES",
        "first_name": "JOHN",
        "middle_name": "WILSON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A66241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nasrin Saleh Jouneghani
• Yamin Sallowm, M.D
• Ryan Je Salvador, MD
• Samir Macwan, M.D., Inc.
• Victor Manuel Samperio, MD
• Esther San Roman Rodriguez, MD
• Joseph M Sanchez, MD
• Mary Anne Sanchez
• Eric Martin Sanderson, M.D.
• Michael Adam Sanford, MD

• Internal Medicine Physician in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.