Blake Patrick Sampson, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

91787531205 Issued in UT

Practice address

University of Utah Department of Dermatology
30 N 1900 E
Salt Lake City, UT 84132-0001

Phone

(801) 581-6465

NPI assigned

Apr 9, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

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

Dermatology

Education

University of Washington School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Associates PLLPGroup PAC ID 5193617223, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Logan Health Medical Center Hospital, Kalispell, MT, CCN 270051
• Logan Health - Whitefish Hospital, Whitefish, MT, CCN 271336

Merit-based Incentive Payment System (MIPS)

Final score

89.9 of 100Reported as group

Quality

86.45

Improvement activities

40

Cost

84.42

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

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.

• Dermatology Associates PLLP

  • Dermatology Physician
  • Kalispell, MT
  • NPI 1114093846
  Medicare reassignment Care Compare group NPD

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

• Kalispell Regional Medical Center Inc

  • Surgical Oncology Physician
  • Kalispell, MT
  • NPI 1053790063

  Hospital

  Care Compare affiliation
• Kalispell Regional Medical Center Inc

  • Maternal & Fetal Medicine Physician
  • Kalispell, MT
  • NPI 1053798710

  Hospital

  Care Compare affiliation
• Kalispell Regional Medical Center Inc

  • General Acute Care Hospital
  • Kalispell, MT
  • NPI 1417945627
  Care Compare affiliation
• Kalispell Regional Medical Center Inc

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Kalispell, MT
  • NPI 1477989770

  Hospital

  Care Compare affiliation
• Kalispell Regional Medical Center Inc

  • Nephrology Physician
  • Kalispell, MT
  • NPI 1700277837

  Hospital

  Care Compare affiliation
• Kalispell Regional Medical Center Inc

  • Hematology & Oncology Physician
  • Kalispell, MT
  • NPI 1891151122

  Hospital

  Care Compare affiliation
• Kalispell Regional Medical Center Inc

  • Obstetrics & Gynecology Physician
  • Kalispell, MT
  • NPI 1972982981

  Hospital

  Care Compare affiliation
• Logan Health - Whitefish

  • Critical Access Hospital
  • Whitefish, MT
  • NPI 1396710851
  Care Compare affiliation

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494288000000",
    "number": "1588007520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF UTAH DEPARTMENT OF DERMATOLOGY",
            "address_2": "30 N 1900 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-6465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF UTAH DEPARTMENT OF DERMATOLOGY",
            "address_2": "30 N 1900 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-6465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPSON",
        "first_name": "BLAKE",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-09",
        "last_updated": "2017-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "MRM-1316",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "UT",
            "license": "91787753",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "UT",
            "license": "91787753",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "UT",
            "license": "91787531205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manuel Ernesto Samora Jr.
• Matthew Howard Samore, MD
• Sarah Hopkins Samore, LCSW
• Wade Stewart Samowitz, MD
• Allison Sampson, M.ED.
• Judith Sawaya Sampson, APRN
• Kathryn Sampson
• Sams West Inc
• Lisa J Samson-Fang, MD
• Kate Keller Samson, PSYD

• Dermatology Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Dermatology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2017; 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.