NPIMap

Individual provider Active NPI

Samson Mulu Ambaw, MD

  • Nephrology Physician
  • Midwest City, OK
National Provider Identifier
1356521033
Registry record updated Feb 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
28940 Issued in OK
Practice address
9230 E. Reno Ave Suite B
Midwest City, OK 73130
Phone
(405) 737-4900
Fax
(405) 737-3606
NPI assigned
Nov 9, 2007
Last updated
Feb 11, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 62937 GA
Nephrology Physician 207RN0300X 28940 OK Primary
Hospitalist Physician 208M00000X N3441 TX

Addresses

Primary practice location

9230 E. Reno Ave Suite B
Midwest City, OK 73130

Mailing address

9230 E. Reno Ave Suite B
Midwest City, OK 73130
Phone (405) 737-4900

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
I20120815000183 OK Practitioner - NephrologyPractitioner - Internal Medicine 6507902913 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Nephrology Group PLLCGroup PAC ID 7214210624, 5 clinicians

Practice addresses (Care Compare)

9230 E Reno Ave
Suite B
Midwest City, OK 73130-3337
Phone (405) 737-4900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
96.62
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62937GAMDInternal Medicine Physician
28940OKMDNephrology Physician
N3441TXMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Nephrology Group PLLC Nephrology CurrentSince Mar 27, 2017 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
SSM Health Care of Oklahoma, Inc Past Accepting new patients

Locations

9230 E Reno Ave
Ste B
Oklahoma City, OK 73130
Phone (405) 737-4900

Interoperability endpoints

  • Direct secure messaging: sambaw@yourcarecommunity.org
  • Direct secure messaging: sambaw63157@direct-ehr-ssmhc.com

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 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423612800000",
    "number": "1356521033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9230 E. RENO AVE SUITE B",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "73130",
            "telephone_number": "405-737-4900",
            "fax_number": "405-737-3606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9230 E. RENO AVE SUITE B",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "73130",
            "telephone_number": "405-737-4900",
            "fax_number": "405-737-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBAW",
        "first_name": "SAMSON",
        "middle_name": "MULU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-09",
        "last_updated": "2015-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "62937",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OK",
            "license": "28940",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "N3441",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midwest City, OK

Sources for this page

Verify at the official NPI Registry.