Active NPI
Corey Jeffrey Samuelson, DPT
- Physical Therapist
- Bismarck, ND
National Provider Identifier
1649454307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1474
- Practice address
- 1033 Basin Ave
Bismarck, ND 58504-6649 - Phone
- (701) 223-6613
- NPI assigned
- Dec 18, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1474 | ND | Primary |
Addresses
Primary practice location
1033 Basin Ave
Bismarck, ND 58504-6649
Mailing address
300 N 31St St Apt 40
Bismarck, ND 58501-5101
Phone (701) 570-3480
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1474 | ND | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McKenzie County Healthcare Systems Inc | Past | Accepting new patients | |
| McKenzie County Healthcare Systems Inc | Past | Accepting new patients | |
| McKenzie County Healthcare Systems Inc | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Medicare Defined Swing Bed Hospital Unit
- Watford City, ND
- NPI 1427079854
-
- Rural Health Clinic/Center
- Watford City, ND
- NPI 1457374217
-
- Obstetrics & Gynecology Physician
- Watford City, ND
- NPI 1689364598
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198108800000",
"number": "1649454307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 N 31ST ST APT 40",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585015101",
"telephone_number": "701-570-3480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1033 BASIN AVE",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585046649",
"telephone_number": "701-223-6613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUELSON",
"first_name": "COREY",
"middle_name": "JEFFREY",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-18",
"last_updated": "2007-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ND",
"license": "1474",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bismarck, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.