NPIMap

Individual provider Active NPI

Derek Samuels, MD

  • Vascular & Interventional Radiology Physician
  • Mobile, AL
National Provider Identifier
1558523910
Registry record updated Jul 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
ME116198 Issued in FL
Practice address
2451 Fillingim St
Mastin 102
Mobile, AL 36617-2238
Phone
(251) 470-5890
Fax
(251) 471-7925
NPI assigned
Jun 27, 2008
Last updated
Jul 14, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Vascular & Interventional Radiology Physician 2085R0204X ME116198 FL Primary

Addresses

Primary practice location

2451 Fillingim St
Mastin 102
Mobile, AL 36617-2238

Mailing address

PO Box 40480
Mobile, AL 36640-0480
Phone (251) 470-5890

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20151009001349 FL Practitioner - Diagnostic Radiology 8325269319 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Eastern Virginia Medical School, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Associates of ClearwaterGroup PAC ID 5496732067, 54 clinicians
St Josephs Diagnostic Center LLCGroup PAC ID 3779484928, 89 clinicians
Morton Plant Health Services IncGroup PAC ID 2163336777, 88 clinicians

Practice addresses (Care Compare)

300 Pinellas St
Clearwater, FL 33756-3804
Phone (727) 462-7000

3003 W Dr MLK Blvd
Tampa, FL 33607-6307
Phone (813) 870-4826

8787 Bryan Dairy Rd
Largo, FL 33777-1251
Phone (727) 391-4758

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Morton Plant Mease Health Services Inc CurrentSince Oct 1, 2015 Accepting new patients
Baycare Outpatient Imaging LLC CurrentSince Feb 19, 2026 Accepting new patients
Morton Plant Mease Health Services Inc Current Accepting new patients
St Josephs Diagnostic Center LLC CurrentSince Feb 14, 2018 Accepting new patients
Morton Plant Mease Health Services Inc CurrentSince Oct 1, 2015 Accepting new patients
St Joseph's Diagnostic Center LLC CurrentSince Feb 14, 2018 Accepting new patients
Radiology Associates of Clearwater CurrentSince Aug 17, 2015 Accepting new patients
Premier Radiology, LLP Past Accepting new patients

Locations

1106 Druid Rd S
Ste 302
Clearwater, FL 33756

300 Pinellas St
Clearwater, FL 33756
Phone (727) 461-8552

323 Jeffords St
Clearwater, FL 33756
Phone (727) 462-7560

601 Main St
Dunedin, FL 34698
Phone (727) 461-1133

18600 Fernview St
Ste 101
Land O Lakes, FL 34638
Phone (813) 692-8010

6600 Madison St
New Pt Richey, FL 34652
Phone (727) 841-4611

3890 Tampa Rd
#H
Palm Harbor, FL 34684
Phone (813) 781-3164

8787 Bryan Dairy Rd
Seminole, FL 33777
Phone (727) 391-4758

3003 W Mlk Blvd
Tampa, FL 33607
Phone (813) 357-0630

2102 Trinity Oaks Blvd
Trinity, FL 34655
Phone (727) 372-4000

2470 Bloomingdale Ave
Ste 115
Valrico, FL 33596
Phone (727) 281-9479

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1214524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1558523910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40480",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366400480",
            "telephone_number": "251-470-5890",
            "fax_number": "251-471-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2451 FILLINGIM ST",
            "address_2": "MASTIN 102",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366172238",
            "telephone_number": "251-470-5890",
            "fax_number": "251-471-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "DEREK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-27",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "FL",
            "license": "ME116198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

Verify at the official NPI Registry.