Randall Jay Sampson

Primary specialty

ContractorTaxonomy code 171W00000X

License

BC743839 Issued in MN

Practice address

24668 Hamlet Ave
Forest Lake, MN 55025-8781

Phone

(612) 290-9056

Fax

(651) 464-5671

NPI assigned

Jan 30, 2020

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Sampson Construction

  • Home Modifications Contractor
  • Forest Lake, MN
  • NPI 1841827870
  NPD Authorized official

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580342400000",
    "number": "1295366029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24668 HAMLET AVE",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550258781",
            "telephone_number": "612-290-9056",
            "fax_number": "651-464-5671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24668 HAMLET AVE",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550258781",
            "telephone_number": "612-290-9056",
            "fax_number": "651-464-5671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPSON",
        "first_name": "RANDALL",
        "middle_name": "JAY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-30",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "MN",
            "license": "BC743839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "sampsonconst@gmail.com",
            "affiliation": "N",
            "address_1": "24668 Hamlet Ave",
            "city": "Forest Lake",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550258781",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicole Rae Ruotsinoja, PTA
• Catharine B Ruther, DDS
• S & S Spa Salon Inc
• Brett J Salek, M.D.
• Sampson Construction
• Cassandra Saunders, PHARMD
• Savi Services, Inc (Lakes Counseling)
• Ervin George Savord, D.D.S.
• Rita Lynn Scanlan, OTR/L
• Vladimir Joseph Scharafanow, MT

• Contractor in Forest Lake, MN
• Providers in Forest Lake, MN by specialty
• Contractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.