NPIMap

Individual provider Active NPI

Samuel Lyle Hague, MD

  • Family Medicine Physician
  • Blackwell, OK
National Provider Identifier
1528064763
Registry record updated Mar 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
22530 Issued in OK
Practice address
1009 W Ferguson Ave
Blackwell, OK 74631-5602
Phone
(580) 363-0052
Fax
(580) 363-0894
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 22530 OK Primary

Addresses

Primary practice location

1009 W Ferguson Ave
Blackwell, OK 74631-5602

Mailing address

1009 W Ferguson Ave
Blackwell, OK 74631-5602
Phone (580) 363-0052

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040601000681 OK Practitioner - Emergency MedicinePractitioner - Family Practice 5496736886 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
University of Oklahoma College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
AMC Urgent Care Plus LLCGroup PAC ID 3971509381, 16 clinicians

Practice addresses (Care Compare)

1009 W Ferguson Ave
Blackwell, OK 74631-5602
Phone (580) 363-0052

1909 W 6TH Ave
Suite B
Stillwater, OK 74074-4204
Phone (405) 385-0029

2101 N 14TH St
Ponca City, OK 74601-1807
Phone (580) 762-2366

816 W Tucson St
Broken Arrow, OK 74011-7290
Phone (580) 762-2366

9003 N Garnett Rd
Owasso, OK 74055-4495
Phone (918) 272-2882

Hospital & facility affiliations

  • Elara Caring Xviii Home health agency, Stillwater, OK, CCN 377742
  • Angels Care Home Health of East Oklahoma Home health agency, Broken Arrow, OK, CCN 377171
  • Acg Hospice III Hospice, Elk City, OK, CCN 371711
  • Acg Hospice II Hospice, Oklahoma City, OK, CCN 371730
  • Acg Hospice Hospice, Grove, OK, CCN 371623
  • Stillwater Medical-Blackwell Hospital, Blackwell, OK, CCN 370780
  • Integris Health Ponca City Hospital, Ponca City, OK, CCN 370006
  • Stillwater Medical Center Hospital, Stillwater, OK, CCN 370049

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22530OKMDCase Manager/Care Coordinator

Practice roles

OrganizationSpecialtyStatusNew patients
AMC Urgent Care Plus, LLC CurrentSince Sep 1, 2006 Accepting new patients
Samuel L Hague MD PC Family Medicine CurrentSince Aug 1, 2004 Accepting new patients
Triad Complete Healthcare A06 LLC Past Accepting new patients
Newkirk Rural Health Clinic Family Medicine Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

1009 W Ferguson Ave
Blackwell, OK 74631
Phone (580) 363-0052

816 W Tucson St
Broken Arrow, OK 74011
Phone (580) 762-2366

9003 N Garnett Rd
Owasso, OK 74055
Phone (918) 272-2882

2101 N 14th St
Ste 114
Ponca City, OK 74601
Phone (580) 762-1552

1909 W 6th Ave
#B
Stillwater, OK 74074
Phone (405) 385-0029

Interoperability endpoints

  • Direct secure messaging: samuel.hague.1@31440.direct.athenahealth.com

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 8

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": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206403200000",
    "number": "1528064763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 W FERGUSON AVE",
            "city": "BLACKWELL",
            "state": "OK",
            "postal_code": "746315602",
            "telephone_number": "580-363-0052",
            "fax_number": "580-363-0894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 W FERGUSON AVE",
            "city": "BLACKWELL",
            "state": "OK",
            "postal_code": "746315602",
            "telephone_number": "580-363-0052",
            "fax_number": "580-363-0894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGUE",
        "first_name": "SAMUEL",
        "middle_name": "LYLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "22530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blackwell, OK

Sources for this page

Verify at the official NPI Registry.