Jason Samuel Chartered

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

JASON SAMUEL CHARTERED

Practice address

110 Third St
Suite 310
Henderson, KY 42420

Phone

(270) 826-1266

Fax

(270) 827-5385

NPI assigned

Nov 21, 2006

Reactivated

May 18, 2015

Organization subpart

No

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

Authorized official

Name

Jason T Samuel, MD

Title

President

Phone

(270) 826-1266

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431907200000",
    "number": "1629143342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1247",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "42420",
            "telephone_number": "270-826-1266",
            "fax_number": "270-827-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 THIRD ST",
            "address_2": "SUITE 310",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "42420",
            "telephone_number": "270-826-1266",
            "fax_number": "270-827-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASON SAMUEL CHARTERED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2015-05-18",
        "deactivation_date": "2015-04-28",
        "reactivation_date": "2015-05-18",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-826-1266",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100038670",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200893090A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Island Medical Henderson LLC
• J. R. Holdings, Inc
• James a Hohman MD, PSC
• Tamara James, LMFT
• Sarah Elizabeth Jankowski, OT
• Bailey Nicole Jenkins, COTA
• Andrea S Jennings, PA-C, RD
• Gary L Jennings, DMD
• Jackson Clay Jennings, DMD
• Jessica H. Renaker, DMD PLLC

• Gastroenterology Physician in Henderson, KY
• Providers in Henderson, KY by specialty
• Gastroenterology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.