Individual provider Active NPI

Jonathan Samuel, M.D., M.P.H.

  • Surgery Physician
  • Clackamas, OR
National Provider Identifier
1457570723
Registry record updated Oct 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2007-00921 Issued in NC
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

Updated by the provider on Oct 10, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141204001323 OR Practitioner - General Surgery 6406000546 Reassigns benefits to 1 organization
I20200413000012 WA Practitioner - General Surgery 6406000546 Reassigns benefits to 1 organization

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
Kaiser Foundation Health Plan of the NorthwestGroup PAC ID 5799688230, 1,805 clinicians

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 Hospital, Clackamas, OR, CCN 380091

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2007-00921NCMDSurgical Critical Care Physician
107742MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest Surgery CurrentSince Feb 29, 2020 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Surgery Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Dec 15, 2014 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Surgery CurrentSince Dec 15, 2014 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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

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

Verify at the official NPI Registry.