NPIMap

Individual provider Active NPI

Winston L Samuels, MD

  • Family Medicine Physician
  • Lawrenceville, GA
National Provider Identifier
1306069380
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
60867 Issued in GA
Practice address
1846 Old Norcross Rd Ste 100
Lawrenceville, GA 30044-8801
Phone
(404) 738-7878
Fax
(404) 999-4968
NPI assigned
Apr 10, 2007
Last updated
Sep 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 60867 GA Primary
General Practice Physician 208D00000X 060867 GA

Addresses

Primary practice location

1846 Old Norcross Rd Ste 100
Lawrenceville, GA 30044-8801

Mailing address

1846 Old Norcross Rd Ste 100
Lawrenceville, GA 30044-8801
Phone (404) 738-7878

Other identifiers 1

IdentifierTypeStateIssuer
492804824LMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080715000247 GA Practitioner - Family Practice 0749353423 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Howard University College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1846 Old Norcross Rd
Suite 100
Lawrenceville, GA 30044-8801
Phone (404) 738-7878

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60867GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gwinnett Family Medical Care Family Medicine Current Accepting new patients
Trust Health MD CurrentSince Jan 19, 2024 Accepting new patients
Balanced Life Health Care Solutions LLC PastSince Jul 24, 2022 Accepting new patients

Locations

1846 Old Norcross Rd
Lawrenceville, GA 30044

1846 Old Norcross Rd
Ste 100
Lawrenceville, GA 30044
Phone (404) 738-7878

3725 Zoar Rd
Snellville, GA 30039
Phone (770) 979-1818

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CFCCDD/Endpoint/CFCCDD

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
Tropical Health Hospice of GeorgiaSnellville, GA, CCN 851549 Hospice W-2 Managing Employee Mar 20, 2020

Owned or controlled facilities with NPI records 2

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

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1306069380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1846 OLD NORCROSS RD STE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300448801",
            "telephone_number": "404-738-7878",
            "fax_number": "770-736-7134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1846 OLD NORCROSS RD STE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300448801",
            "telephone_number": "404-738-7878",
            "fax_number": "404-999-4968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "WINSTON",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "60867",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "060867",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "492804824L",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.