Individual provider Active NPI

Samuel J Wallum, MD

  • Anesthesiology Physician
  • Spokane, WA
National Provider Identifier
1285044313
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD60851653 Issued in WA
Practice address
101 W 8TH Ave
Spokane, WA 99204
Phone
(509) 474-3181
NPI assigned
Apr 28, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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 TL.0005746 CO
Internal Medicine Physician 207R00000X BP10050008 TX
Anesthesiology Physician 207L00000X MD60851653 WA Primary

Addresses

Primary practice location

101 W 8TH Ave
Spokane, WA 99204

Mailing address

101 W 8TH Ave
Spokane, WA 99204-2307
Phone (509) 474-3181

Other practice location 1

12631 E 17th Ave Ste 2001
University of Colorado School of Medicine
Aurora, CO 80045-2527
Phone (303) 724-1758

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20180702002245 WA Practitioner - Anesthesiology 6305167388 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Texas Medical Branch at Galveston, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Service- WashingtonGroup PAC ID 0840279758, 170 clinicians

Practice addresses (Care Compare)

101 W 8TH Ave
Spokane, WA 99204-2307
Phone (509) 474-3131

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.73 of 100Reported as group
Quality
83.21
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TL.0005746COMDAnesthesiology Physician
BP10050008TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Service- Washington Anesthesiology CurrentSince Jul 15, 2018 Accepting new patients

Locations

5633 N Lidgerwood St
Spokane, WA 99208
Phone (509) 482-0111

101 W 8th Ave
Bldg 3RD
Spokane, WA 99204

101 W 8th Ave
Spokane, WA 99204
Phone (509) 474-3181

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1398643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528675200000",
    "number": "1285044313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W 8TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042307",
            "telephone_number": "509-474-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W 8TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "99204",
            "telephone_number": "509-474-3181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12631 E 17th Ave Ste 2001",
            "address_2": "University of Colorado School of Medicine",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800452527",
            "country_code": "US",
            "telephone_number": "303-724-1758",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLUM",
        "first_name": "SAMUEL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-28",
        "last_updated": "2018-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CO",
            "license": "TL.0005746",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "BP10050008",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD60851653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.