Jeffrey Neil Samuelson, M.D.

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

40515 Issued in MN

Practice address

1414 Woodland Ave
Duluth, MN 55803-2624

Phone

(218) 302-1000

NPI assigned

Dec 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Micrographic Dermatologic Surgery (MDS)

Education

R Franklin University of Med & Sci/Chicago Medical School, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Twin Ports Dermatology IncGroup PAC ID 0244542454, 8 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Twin Ports Dermatology Inc

  • Physician Assistant
  • Duluth, MN
  • NPI 1316348725
  Medicare reassignment Care Compare group NPD
• Skin Care Doctors, P.a.

  • Medical Specialty Clinic/Center
  • Burnsville, MN
  • NPI 1851516397
  NPD
• Reese Surgical Group PLLC

  • Vascular Surgery Physician
  • Edina, MN
  • NPI 1972762631
  NPD (past)

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1407912678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 WOODLAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558032624",
            "telephone_number": "952-898-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 WOODLAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558032624",
            "telephone_number": "218-302-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "JEFFREY",
        "middle_name": "NEIL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "40515",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MN",
            "license": "40515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "860217400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joann Irene Salmela
• Barbara Ann Salminen, DOULA
• David Russell Salo, PHARM.D
• Kimberly Salo, RN, CNP
• Benjamin Sam, DPT
• Sara San Felipo, CNP
• Megan Elaine Sandberg, MD
• Peter E. Sandelin
• Wendy Hunt Sandelin
• Kathryn Jane Sandell, APRN, CNM

• MOHS-Micrographic Surgery Physician in Duluth, MN
• Providers in Duluth, MN by specialty
• MOHS-Micrographic Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.