Samuelson Enterprises, PLLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

SAMUELSON ENTERPRISES, PLLC

Doing business as

Grace Wellness Clinic

Practice address

3930 Mount Vernon Dr
Bloomfield Hills, MI 48301-3226

Phone

(202) 262-2218

NPI assigned

Jan 12, 2018

Last updated

Oct 29, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Prof. Bensson Varghese Samuel, MD, PHD, DBA, ED.DNPI 1710240403

Title

Director/Owner

Phone

(248) 792-9864

Specialties & licenses 15

Addresses

Other identifiers 1

Other names 1

• Grace Wellness Clinic Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bensson Varghese Samuel, M.D,

  • Internal Medicine Physician
  • Bridgeport, CT
  • NPI 1710240403

  Emergency Medicine

  NPD Authorized official

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

{
    "created_epoch": "1515715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1386152296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 ASHMUN ST UNIT 5",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831936",
            "telephone_number": "202-262-2218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 MOUNT VERNON DR",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483013226",
            "telephone_number": "202-262-2218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUELSON ENTERPRISES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-12",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "BENSSON",
        "authorized_official_middle_name": "VARGHESE",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "248-792-9864",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "MD, PHD, DBA, ED.D"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Corporate Health",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MI",
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "343800000X",
            "taxonomy_group": "",
            "desc": "Secured Medical Transport (VAN)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2050X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care Camp",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0005X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hypertension Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710240403",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grace Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health Service Clinic/Center in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Health Service Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; 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.