Active NPI
Jonathan Samuel, M.D., M.P.H.
- Surgery Physician
- Clackamas, OR
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 2007-00921
- Practice address
- 10180 SE Sunnyside Rd
Clackamas, OR 97015-8970 - Phone
- (503) 652-2880
- NPI assigned
- Apr 25, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 2007-00921 | NC | Primary |
| Surgical Critical Care Physician | 2086S0102X | 2007-00921 | NC |
Addresses
Primary practice location
10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Mailing address
10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR, WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- General Surgery
- Education
- Northwestern University Feinberg Medical School, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
10100 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000
10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone (800) 813-2000
Hospital & facility affiliations
- Kaiser Sunnyside Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2007-00921 | NC | MD | Surgical Critical Care Physician |
| 107742 | MN | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaiser Foundation Health Plan of the Northwest | Surgery | Current | Accepting new patients |
| Kaiser Foundation Health Plan of the Northwest | Surgery | Current | Accepting new patients |
| Kaiser Foundation Health Plan of the Northwest | Current | Accepting new patients | |
| Kaiser Foundation Health Plan of the Northwest | Surgery | Current | Accepting new patients |
| Kaiser Foundation Hospitals | Past | Accepting new patients |
Locations
10180 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2880
10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946
7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051
2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400
1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801
7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000
Organizations & group practices 5
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.
-
- General Practice Physician
- Portland, OR
- NPI 1184786527
Surgery, WA
-
- General Practice Physician
- Portland, OR
- NPI 1306192455
Surgery
-
- General Practice Physician
- Portland, OR
- NPI 1871848457
Surgery
-
- Clinic/Center
- Hillsboro, OR
- NPI 1942718622
-
- General Acute Care Hospital
- Clackamas, OR
- NPI 1124182902
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Clackamas, OR
- NPI 1124182902
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412899200000",
"number": "1457570723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10180 SE SUNNYSIDE RD",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "970158970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10180 SE SUNNYSIDE RD",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "970158970",
"telephone_number": "503-652-2880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "JONATHAN",
"credential": "M.D., M.P.H.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-25",
"last_updated": "2014-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "2007-00921",
"primary": true
},
{
"code": "2086S0102X",
"taxonomy_group": "",
"desc": "Surgery, Surgical Critical Care",
"state": "NC",
"license": "2007-00921",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Clackamas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2014; 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.