Gregory L Samuelson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

01841 Issued in IA

Practice address

116 E Washington St
Clarinda, IA 51632-1611

Phone

(712) 542-6513

Fax

(712) 542-2274

NPI assigned

Nov 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in IA

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

Optometry

Education

Illinois College of Optometry at Chicago, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eyecare Associates of Southwest Iowa IncGroup PAC ID 0749179331, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Eyecare Associates of Southwest Iowa Inc

  • Optometrist
  • Clarinda, IA
  • NPI 1801887484
  Medicare reassignment Care Compare group NPD Authorized official
• Eyecare Associates of Southwest Iowa Inc

  • Optometrist
  • Shenandoah, IA
  • NPI 1659362234
  NPD

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343952000000",
    "number": "1487645156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N 18TH ST",
            "city": "CLARINDA",
            "state": "IA",
            "postal_code": "516321524",
            "telephone_number": "712-542-5461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 E WASHINGTON ST",
            "city": "CLARINDA",
            "state": "IA",
            "postal_code": "516321611",
            "telephone_number": "712-542-6513",
            "fax_number": "712-542-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "GREGORY",
        "middle_name": "L",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2012-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "01841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07428",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLOCK VISION",
            "identifier": "1487645156",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100249544-00",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2262956",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE",
            "identifier": "24362",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "22-00001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07423",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "930454",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benn Rayment, ARNP
• George William Richardson, M.D.
• Nikki Michella Rock, R.N.
• Teresa B Rosales, M.D.
• Lydia Rothfusz, LMSW
• Bryon Jon Schaeffer, M.D.
• Danielle Schalk, TLMHC
• Kimberly Schoonover, ARNP
• Bethany Sheffield
• William John Shelton, M.D.

• Optometrist in Clarinda, IA
• Providers in Clarinda, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2012; 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.