NPIMap

Individual provider Active NPI

Julia Mary John Samuel, DNP, FNP-C

  • Family Nurse Practitioner
  • Oklahoma City, OK
National Provider Identifier
1336630888
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R0109634 Issued in OK
Practice address
4120 W Memorial Rd Ste 102
Oklahoma City, OK 73120-9322
Phone
(405) 749-4205
Fax
(405) 749-4248
NPI assigned
May 21, 2018
Last updated
Feb 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R0109634 OK Primary

Addresses

Primary practice location

4120 W Memorial Rd Ste 102
Oklahoma City, OK 73120-9322

Mailing address

4120 W Memorial Rd Ste 102
Oklahoma City, OK 73120-9322
Phone (405) 749-4205

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20181020000640 OK Practitioner - Nurse Practitioner 8325391311 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fands Physical Therapy, IncGroup PAC ID 7810898459, 217 clinicians
Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

1414 Hwy 71 N
Alma, AR 72921-4723
Phone (479) 632-0321

4120 W Memorial Rd
Suite 205
Oklahoma City, OK 73120-9322
Phone (405) 749-4205

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Oklahoma Communities CurrentSince Mar 1, 2022 Accepting new patients

Locations

4120 W Memorial Rd
Ste 205
Oklahoma City, OK 73120
Phone (405) 749-2992

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

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 12

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": "1526860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1336630888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4120 W MEMORIAL RD STE 102",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731209322",
            "telephone_number": "405-749-4205",
            "fax_number": "405-749-4248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4120 W MEMORIAL RD STE 102",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731209322",
            "telephone_number": "405-749-4205",
            "fax_number": "405-749-4248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN SAMUEL",
        "first_name": "JULIA",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "DNP, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-21",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0109634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.