NPIMap

Individual provider Active NPI

Samuel E Ross, M.D.

  • Family Medicine Physician
  • Wakeman, OH
National Provider Identifier
1275979296
Registry record updated Oct 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.135213 Issued in OH
Practice address
24 Hyde St
Wakeman, OH 44889-9301
Phone
(440) 839-2226
Fax
(440) 839-1339
NPI assigned
May 16, 2013
Last updated
Oct 1, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35.135213 OH
Family Medicine Physician 207Q00000X 35.135213 OH Primary
Family Medicine Physician 207Q00000X 4301108033 MI

Addresses

Primary practice location

24 Hyde St
Wakeman, OH 44889-9301

Mailing address

272 Benedict Ave
Norwalk, OH 44857-2374
Phone (419) 668-8101

Other identifiers 1

IdentifierTypeStateIssuer
0330079MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sross43191@lickingmemorial.medicity.net Licking Memorial Health Professionals

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, OH, FL, VA4 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 4

Enrollment IDStateProvider typePAC IDDetails
I20170607001747 MI Practitioner - Family PracticePractitioner - Emergency Medicine 8921223272 Reassigns benefits to 3 organizations
I20190205001779 OH Practitioner - Family Practice 8921223272 Reassigns benefits to 5 organizations
I20260602002783 FL Practitioner - Emergency Medicine 8921223272 Reassigns benefits to 1 organization
I20260608000504 VA Practitioner - Emergency Medicine 8921223272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
M Medical Mi PLLCGroup PAC ID 6002332012, 13 clinicians
Pai Participant 1 LLCGroup PAC ID 8123351954, 174 clinicians

Practice addresses (Care Compare)

1920 Cleveland Rd W
Huron, OH 44839-1249
Phone (419) 433-4990

20 W Locust St
Newark, OH 43055-5520
Phone (220) 564-4835

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.135213OHMDEmergency Medicine Physician
4301108033MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pai Participant 1 LLC CurrentSince Dec 17, 2025 Accepting new patients
M Medical Mi PLLC CurrentSince Aug 28, 2025 Accepting new patients
Licking Memorial Health Professionals Family Medicine CurrentSince Aug 4, 2025 Accepting new patients
Licking Memorial Professional Corporation CurrentSince Aug 4, 2025 Accepting new patients
Fisher-Titus Medical Care LLC Family Medicine CurrentSince Feb 1, 2022 Accepting new patients
M Medical Mi PLLC CurrentSince Aug 28, 2025 Accepting new patients
Signify Health, LLC CurrentSince Dec 13, 2025 Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince Dec 13, 2025 Accepting new patients
Pai Participant 18 PC CurrentSince Dec 23, 2025 Accepting new patients
Fisher-Titus Medical Center Current Accepting new patients
Optalis Kingsford Opco LLC Past Accepting new patients
Huron Health Care Center, Inc. Past Accepting new patients
St Clair Opco LLC Past Accepting new patients
Orchardview Physicians PastSince Dec 5, 2018 Accepting new patients
Medilodge of Yale Inc Past Accepting new patients

Locations

5201 Conner St
Detroit, MI 48213
Phone (313) 571-5555

3003 W Grand River Ave
Howell, MI 48843
Phone (517) 323-9133

90 Jean St
Yale, MI 48097
Phone (810) 387-3226

13 N Washington St
Ypsilanti, MI 48197
Phone (734) 329-4620

230 Cherry St
Chillicothe, OH 45601
Phone (740) 773-6470

175 S 3rd St
Ste 200
Columbus, OH 43215
Phone (267) 817-8902

1920 Cleveland Rd W
Huron, OH 44839
Phone (419) 433-4990

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

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

14 Westgate Dr
Newark, OH 43055
Phone (220) 564-7500

20 W Locust St
Newark, OH 43055
Phone (220) 564-4835

272 Benedict Ave
Norwalk, OH 44857
Phone (419) 423-5197

54 S Washington St
Tiffin, OH 44883
Phone (419) 447-6885

24 Hyde St
Wakeman, OH 44889
Phone (440) 839-0039

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Interoperability endpoints

  • Direct secure messaging: samuelross@bpsoh.allscriptsdirect.net
  • Direct secure messaging: sross43191@lickingmemorial.medicity.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Premier Hospice, LLCTroy, MI, CCN 231623 Hospice Contracted Managing Employee Nov 10, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1368662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790812800000",
    "number": "1275979296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 BENEDICT AVE",
            "city": "NORWALK",
            "state": "OH",
            "postal_code": "448572374",
            "telephone_number": "419-668-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 HYDE ST",
            "city": "WAKEMAN",
            "state": "OH",
            "postal_code": "448899301",
            "telephone_number": "440-839-2226",
            "fax_number": "440-839-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "SAMUEL",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-16",
        "last_updated": "2026-10-01",
        "certification_date": "2026-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35.135213",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.135213",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301108033",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0330079",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sross43191@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 Wakeman, OH

Sources for this page

Verify at the official NPI Registry.