Active NPI
Samuel James Mumpower, D.M.D.
- Endodontics
- Rome, GA
National Provider Identifier
1336205251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 012200
- Practice address
- 160 Three Rivers Dr NE
Suite 1600
Rome, GA 30161-2303 - Phone
- (706) 291-0095
- NPI assigned
- Dec 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 012200 | GA | Primary |
Addresses
Primary practice location
160 Three Rivers Dr NE
Suite 1600
Rome, GA 30161-2303
Mailing address
1901 J L Todd Dr
Rome, GA 30161-5015
Phone (706) 291-0095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160107001638 | GA | Order and Referring Only - Dentist | 6901108976 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012200 | GA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451347200000",
"number": "1336205251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 J L TODD DR",
"city": "ROME",
"state": "GA",
"postal_code": "301615015",
"telephone_number": "706-291-0095",
"fax_number": "706-291-0036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 THREE RIVERS DR NE",
"address_2": "SUITE 1600",
"city": "ROME",
"state": "GA",
"postal_code": "301612303",
"telephone_number": "706-291-0095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUMPOWER",
"first_name": "SAMUEL",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-28",
"last_updated": "2015-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "GA",
"license": "012200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rome, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.