NPIMap

Individual provider Active NPI

Charles M Samp, PA-C

  • Physician Assistant
  • Mesa, AZ
National Provider Identifier
1538126545
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1554 Issued in AZ
Practice address
6242 E Arbor Ave
Ste 111
Mesa, AZ 85206-1309
Phone
(480) 610-8183
Fax
(480) 895-3110
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1554 AZ Primary

Addresses

Primary practice location

6242 E Arbor Ave
Ste 111
Mesa, AZ 85206-1309

Mailing address

6242 E Arbor Ave
Mesa, AZ 85206-1309
Phone (480) 610-8183

Other identifiers 1

IdentifierTypeStateIssuer
578841MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20050629000297 AZ Practitioner - Physician Assistant 2062458201 Reassigns benefits to 7 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1554AZMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Professional Association LTD Past Accepting new patients
Total Orthopedics,LLC Past Accepting new patients

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538126545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6242 E ARBOR AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061309",
            "telephone_number": "480-610-8183",
            "fax_number": "480-089-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6242 E ARBOR AVE",
            "address_2": "STE 111",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061309",
            "telephone_number": "480-610-8183",
            "fax_number": "480-895-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMP",
        "first_name": "CHARLES",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "1554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "578841",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.