Samuel Allen Bartrom
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · La Fontaine, IN
NPI 1295570042 · NPPES record last updated Jun 25, 2024
Key facts
- NPI
- 1295570042
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- PO Box 22
La Fontaine, IN 46940-0022 - Phone
- (574) 215-9384
- NPI assigned
- Jun 25, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260603004471 | OH | Order and Referring Only - Family Practice |
5294206934 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
PO Box 22
La Fontaine, IN 46940-0022
Mailing address
PO Box 22
La Fontaine, IN 46940-0022
Phone (574) 215-9384
Other providers in La Fontaine, IN
- Theresa Renee Brown
- Brittany Burnett
- Angela Celina Alcala Castaneda
- Kiley Jean Furnish
- Paul James Knell
All providers in La Fontaine, IN · Student in an Organized Health Care Education/Training Program in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.