Richard Leslie Sample, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO898 Issued in AL

Practice address

4371 Narrow Lane Rd
Montgomery, AL 36116-2971

Phone

(334) 613-3680

Fax

(334) 613-3685

NPI assigned

May 2, 2006

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 5

Medicare fee-for-service enrollment

Enrolled in AL

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 1

Specialty

Emergency MedicineAlso: Family Practice

Education

College of Osteo Med of the Pacific at Pomona, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jackson Hospital and Clinic, IncGroup PAC ID 0547254153, 119 clinicians

Ivy Creek of Elmore LLCGroup PAC ID 8426075508, 99 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jackson Hospital & Clinic Inc Hospital, Montgomery, AL, CCN 010024

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

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.

• Ivy Creek of Elmore, LLC

  • Rural Health Clinic/Center
  • Tallassee, AL
  • NPI 1558868323
  Medicare reassignment Care Compare group NPD
• Jackson Hospital and Clinic, Inc.

  • Emergency Medicine Physician
  • Montgomery, AL
  • NPI 1073264107

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Nes Tennessee Inc

  • Emergency Medicine Physician
  • Montgomery, AL
  • NPI 1437606605
  Medicare reassignment NPD
• Ivy Creek of Elmore, LLC

  • Rural Health Clinic/Center
  • Wetumpka, AL
  • NPI 1508480633

  Family Medicine

  NPD
• Ivycreek of Elmore LLC

  • Basic Emergency Medical Technician
  • Wetumpka, AL
  • NPI 1205034428
  NPD
• Jackson Hospital & Clinic, Inc.

  • Physical Therapist
  • Montgomery, AL
  • NPI 1265325823
  NPD
• Nes Tennessee Inc

  • Emergency Medicine Physician
  • Monroeville, AL
  • NPI 1013519230
  NPD
• Nes Tennessee Inc

  • Emergency Medicine Physician
  • Phenix City, AL
  • NPI 1629609631
  NPD
• Clanton Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Clanton, AL
  • NPI 1669428090
  NPD (past)
• Emcare Physician Providers, Inc.

  • Emergency Medicine Physician
  • Opp, AL
  • NPI 1356391353
  NPD (past)
• Island Medical Coosa Valley LLC

  • Emergency Medicine Physician
  • Florence, AL
  • NPI 1083948558
  NPD (past)
• The Health Care Authority for Baptist Health

  • Clinic/Center
  • Montgomery, AL
  • NPI 1538347067
  NPD (past)

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

• Jackson Hospital & Clinic, Inc.

  • General Acute Care Hospital
  • Montgomery, AL
  • NPI 1043262488
  Care Compare affiliation

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206576000000",
    "number": "1497713200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4371 NARROW LANE RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361162975",
            "telephone_number": "334-613-3680",
            "fax_number": "334-613-3685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4371 NARROW LANE RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361162971",
            "telephone_number": "334-613-3680",
            "fax_number": "334-613-3685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPLE",
        "first_name": "RICHARD",
        "middle_name": "LESLIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2008-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009937494",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0403254",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL",
            "identifier": "630813275",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER #",
            "identifier": "051557580",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "051542076",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sam'S Club Optical
• Robert Charles Samac, CRNP
• Jyoti S Samant, MD
• Stephen W Samelson, M.D.
• Alisha Sample
• Patrick Kyle Sampsell, ATC
• Sams East Inc
• Gilberto Sanchez, MD
• Leah Ouano Sanchez, MD
• Marla Sofia Sanchez

• Family Medicine Physician in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; 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.