Active NPI
Raji Mathew Samuel, DDS
- Dentist
- McMinnville, OR
National Provider Identifier
1336264357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D8431
- Practice address
- 510 NE 8TH St
McMinnville, OR 97128-3910 - Phone
- (503) 472-3147
- NPI assigned
- Mar 20, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D8431 | OR | Primary |
Addresses
Primary practice location
510 NE 8TH St
McMinnville, OR 97128-3910
Mailing address
19553 SW Boulder LN
Beaverton, OR 97007-8903
Phone (503) 860-0809
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- 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 |
|---|---|---|---|---|
| I20160106000928 | OR | Order and Referring Only - Dentist | 4486956547 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8431 | OR | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spectra Dental Care LLC | Current | Accepting new patients |
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.
-
- Dental Clinic/Center
- Beaverton, OR
- NPI 1487545166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631664000000",
"number": "1336264357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19553 SW BOULDER LN",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970078903",
"telephone_number": "503-860-0809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 NE 8TH ST",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971283910",
"telephone_number": "503-472-3147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "RAJI",
"middle_name": "MATHEW",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2021-09-15",
"certification_date": "2021-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D8431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McMinnville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; 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.