Dennis Ray Samuelson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-045578 Issued in IL

Practice address

1300 W Adams St
Macomb, IL 61455-1235

Phone

(309) 836-8751

NPI assigned

Sep 11, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221091200000",
    "number": "1376792648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 W ADAMS ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614551235",
            "telephone_number": "309-836-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W ADAMS ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614551235",
            "telephone_number": "309-836-8751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "DENNIS",
        "middle_name": "RAY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-11",
        "last_updated": "2008-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-045578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trudy Rodenberg, MS,CCC-SLP
• George Roodhouse, D.O
• Marcia Renee Roodhouse, LCPC
• Ladawna Jo Royer, APN
• Sara Harrison Ryan
• Michelle Deann Sargeant, CCC-SLP/L
• Gary Lee Sash, DC MS
• Lindsey Schafer
• Sonja E Schmidt, LCSW
• Leilani Altagracia Segura, MD

• Family Medicine Physician in Macomb, IL
• Providers in Macomb, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.