Active NPI
Samuel G Hawk, DO
- General Practice Physician
- Ham Lake, MN
National Provider Identifier
1366763567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- DOS-1424
- Practice address
- 14326 Rochester St NE
Ham Lake, MN 55304-6266 - Phone
- (612) 486-2226
- NPI assigned
- Jun 22, 2010
- Last updated
- Jul 8, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | DOS-1424 | HI | Primary |
Addresses
Primary practice location
14326 Rochester St NE
Ham Lake, MN 55304-6266
Mailing address
14326 Rochester St NE
Ham Lake, MN 55304-6266
Phone (612) 486-2226
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DOS-1424 | HI | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625702400000",
"number": "1366763567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14326 ROCHESTER ST NE",
"city": "HAM LAKE",
"state": "MN",
"postal_code": "553046266",
"telephone_number": "612-486-2226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14326 ROCHESTER ST NE",
"city": "HAM LAKE",
"state": "MN",
"postal_code": "553046266",
"telephone_number": "612-486-2226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAWK",
"first_name": "SAMUEL",
"middle_name": "G",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-22",
"last_updated": "2021-07-08",
"certification_date": "2021-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "HI",
"license": "DOS-1424",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ham Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.