Active NPI
Samuel M Summers, MD
- Family Medicine Physician
- Caldwell, ID
National Provider Identifier
1649216805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M4192
- Practice address
- 315 E Elm St
Suite 100
Caldwell, ID 83605-4857 - Phone
- (208) 302-7100
- Fax
- (208) 302-7155
- NPI assigned
- Jun 22, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M4192 | ID | Primary |
Addresses
Primary practice location
315 E Elm St
Suite 100
Caldwell, ID 83605-4857
Mailing address
3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 302-7100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003955300 | Medicaid | ID |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4192 | ID | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478736000000",
"number": "1649216805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 E GOLDSTONE WAY",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836421026",
"telephone_number": "208-302-7100",
"fax_number": "208-302-7155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 E ELM ST",
"address_2": "SUITE 100",
"city": "CALDWELL",
"state": "ID",
"postal_code": "836054857",
"telephone_number": "208-302-7100",
"fax_number": "208-302-7155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUMMERS",
"first_name": "SAMUEL",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2016-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M4192",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003955300",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Caldwell, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.