Individual provider Active NPI

Samson John Spilk Wall, MD

  • Internal Medicine Physician
  • Milwaukie, OR
National Provider Identifier
1619169109
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD150633 Issued in OR
Practice address
10150 SE 32ND Ave
Milwaukie, OR 97222-6516
Phone
(503) 513-8641
NPI assigned
Aug 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD150633 OR Primary

Addresses

Primary practice location

10150 SE 32ND Ave
Milwaukie, OR 97222-6516

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494

Other names 1

  • Samson Spilk Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20100325000151 OR Practitioner - Internal MedicinePractitioner - Hospitalist 4183750532 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services OregonGroup PAC ID 0648183608, 1,423 clinicians

Practice addresses (Care Compare)

10150 SE 32ND Ave
Milwaukie, OR 97222-6516
Phone (503) 513-3613

Hospital & facility affiliations

  • Providence Milwaukie Hospital Hospital, Milwaukie, OR, CCN 380082
  • Providence Willamette Falls Medical Center Hospital, Oregon City, OR, CCN 380038

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
South Sound Inpatient Physicians PLLC Internal Medicine CurrentSince Oct 23, 2017 Accepting new patients
Providence Health & Services Oregon CurrentSince Sep 27, 2021 Accepting new patients
Providence Health & Services Oregon CurrentSince Sep 27, 2021 Accepting new patients
Providence Health & Services Oregon CurrentSince Sep 27, 2021 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services Oregon Internal Medicine CurrentSince Sep 27, 2021 Accepting new patients

Locations

9290 SE Sunnybrook Blvd
Ste 210
Clackamas, OR 97015
Phone (503) 216-7960

335 SE 8th Ave
Hillsboro, OR 97123
Phone (503) 681-1111

10123 SE Market St
Portland, OR 97216
Phone (503) 251-6355

1321 NE 99th Ave
Ste 200
Portland, OR 97220
Phone (503) 215-4250

5050 NE Hoyt St
Ste 240
Portland, OR 97213
Phone (503) 215-6480

10150 SE 32nd Ave
Portland, OR 97222
Phone (503) 215-4202

Organizations & group practices 6

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 3

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": "1187308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1619169109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "503-215-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10150 SE 32ND AVE",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226516",
            "telephone_number": "503-513-8641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPILK WALL",
        "first_name": "SAMSON",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-17",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD150633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMSON",
            "last_name": "SPILK",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Milwaukie, OR

Sources for this page

Verify at the official NPI Registry.