NPIMap

Individual provider Active NPI

Samuel Joseph Meadema, MD

  • Otolaryngology Physician
  • Danville, VA
National Provider Identifier
1649225764
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
0101031594 Issued in VA
Practice address
159 Executive Dr
Suite C
Danville, VA 24541-4160
Phone
(434) 792-0830
Fax
(434) 792-0468
NPI assigned
May 24, 2006
Last updated
Oct 10, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 0101031594 VA Primary

Addresses

Primary practice location

159 Executive Dr
Suite C
Danville, VA 24541-4160

Mailing address

159 Executive Dr
Suite C
Danville, VA 24541-4160
Phone (434) 792-0830

Other identifiers 2

IdentifierTypeStateIssuer
040000105OtherVATRAILBLAZER HEALTH ENTERPRISES, LLC
032223OtherVABCBS OF VA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080414000225 VA Practitioner - OtolaryngologyPractitioner - Allergy/Immunology 6103923610 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: Allergy/Immunology
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Danville Physician Practices LLCGroup PAC ID 4688606304, 171 clinicians

Practice addresses (Care Compare)

159 Executive Dr
Suite C
Danville, VA 24541-4160
Phone (434) 792-0830

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101031594VAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Martinsville Physician Practices LLC Otolaryngology CurrentSince Dec 1, 2022 Accepting new patients
Danville Physician Practices LLC CurrentSince May 2, 2015 Accepting new patients
Martinsville Physician Practices LLC CurrentSince Dec 1, 2022 Accepting new patients
Danville Physician Practices LLC CurrentSince May 2, 2015 Accepting new patients
Greensboro Pathology, LLC Current Accepting new patients

Locations

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

142 S Main St
Danville, VA 24541
Phone (434) 799-2100

159 Executive Dr
Ste C
Danville, VA 24541
Phone (434) 792-0830

319 Hospital Dr
Ste 101
Martinsville, VA 24112
Phone (276) 632-3900

319 Hospital Dr
Ste 107
Martinsville, VA 24112
Phone (276) 632-0944

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19847/brand/3/csg/21/fhir/r4
  • Direct secure messaging: samuel.meadema.1@19847.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1649225764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 EXECUTIVE DR",
            "address_2": "SUITE C",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245414160",
            "telephone_number": "434-792-0830",
            "fax_number": "434-792-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 EXECUTIVE DR",
            "address_2": "SUITE C",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245414160",
            "telephone_number": "434-792-0830",
            "fax_number": "434-792-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEADEMA",
        "first_name": "SAMUEL",
        "middle_name": "JOSEPH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "VA",
            "license": "0101031594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAILBLAZER HEALTH ENTERPRISES, LLC",
            "identifier": "040000105",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF VA",
            "identifier": "032223",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, VA

Sources for this page

Verify at the official NPI Registry.