Samuel A Wolde

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

39274 Issued in TX

Practice address

4635 Southwest Fwy Ste 635
Houston, TX 77027-7112

Phone

(713) 850-0049

NPI assigned

Jan 14, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT, AZ, RI, TX4 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 4

Specialty

Clinical Psychologist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Supportive Care I of Rhode Island PCGroup PAC ID 1951793546, 53 clinicians

Step Up Care PC LLCGroup PAC ID 5496088346, 176 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

69.09 of 100Reported as group

Quality

73.07

Promoting interoperability

0

Improvement activities

40

Cost

73.89

Merit-based Incentive Payment System (MIPS)

Final score

87.14 of 100Reported as group

Quality

71.85

Improvement activities

40

Cost

75.41

Merit-based Incentive Payment System (MIPS)

Final score

91.17 of 100Reported as group

Quality

83.48

Improvement activities

40

Cost

67.52

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Supportive Care I of Rhode Island PC

  • Clinical Psychologist
  • Providence, RI
  • NPI 1912666454
  Medicare reassignment Care Compare group NPD
• Step Up Care PC LLC

  • Counselor
  • Danielson, CT
  • NPI 1154884740
  Medicare reassignment Care Compare group
• Deer Oaks Geriatric Services P C

  • Clinical Psychologist
  • San Antonio, TX
  • NPI 1134169287
  Medicare reassignment NPD
• Deer Oaks Mental Health Associates PC

  • Clinical Psychologist
  • Las Cruces, NM
  • NPI 1134175763
  NPD (past)
• Numinus Wellness Ut Inc

  • Psychiatry Physician
  • Springville, UT
  • NPI 1265092282
  NPD (past)

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

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1275173536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10428 W COLTER ST",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853074195",
            "telephone_number": "720-226-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4635 SOUTHWEST FWY STE 635",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770277112",
            "telephone_number": "713-850-0049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLDE",
        "first_name": "SAMUEL",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-14",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": "18390",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "39274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zbigniew Jacek Wojciechowski
• Katharine Deven Wojcik, PH.D.
• Uche Wokemba
• Nkiruka Wokocha, RPH
• Henock T. Wolde-Semait, M.D.
• Chanel Nichole Woldtvedt
• Lily Fekad Woldu, ROT
• Jamie Woleben
• Jeoffrey K Wolens, MD
• Alexandra Grace Wolf, RBT

• Clinical Psychologist in Houston, TX
• Providers in Houston, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; 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.