Active NPI
Samuel Denney, RN
- Mental Health Counselor
- Roseburg, OR
National Provider Identifier
1609450980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 548 SE Jackson St
Roseburg, OR 97470-4983 - Phone
- (541) 672-2691
- Fax
- (833) 299-8415
- NPI assigned
- May 12, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 201390365RN | OR | |
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
548 SE Jackson St
Roseburg, OR 97470-4983
Mailing address
PO Box 1121
Roseburg, OR 97470-0254
Phone (541) 672-2691
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 218156 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201390365RN | OR | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622505600000",
"number": "1609450980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1121",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974700254",
"telephone_number": "541-672-2691",
"fax_number": "833-299-8415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "548 SE JACKSON ST",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974704983",
"telephone_number": "541-672-2691",
"fax_number": "833-299-8415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DENNEY",
"first_name": "SAMUEL",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-12",
"last_updated": "2021-06-01",
"certification_date": "2021-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OR",
"license": "201390365RN",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "218156",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.