Samuel J Daisley, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

34004448 Issued in OH

Practice address

149 E Main St
Box 1117
Andover, OH 44003-9479

Phone

(440) 293-5555

Fax

(440) 293-6643

NPI assigned

Feb 22, 2007

Last updated

Dec 9, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

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.

• Samuel J. Daisley D.O. Inc.

  dba Daisley Family Practice

  • Family Medicine Physician
  • Andover, OH
  • NPI 1023143823
  Authorized official Same address or phone

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260316800000",
    "number": "1669507505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 E MAIN ST",
            "address_2": "BOX 1117",
            "city": "ANDOVER",
            "state": "OH",
            "postal_code": "440039479",
            "telephone_number": "440-293-5555",
            "fax_number": "440-293-6643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 E MAIN ST",
            "address_2": "BOX 1117",
            "city": "ANDOVER",
            "state": "OH",
            "postal_code": "440039479",
            "telephone_number": "440-293-5555",
            "fax_number": "440-293-6643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAISLEY",
        "first_name": "SAMUEL",
        "middle_name": "J",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2009-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34004448",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS006385L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0679930",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000137900",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BCBS- PA LOCATIO",
            "identifier": "1760701",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BCBS- OH LOCATIO",
            "identifier": "092290",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Dawn Bovee, CNP
• Kristopher Butcher
• Darlene Lynn Butler, LPTA
• Amanda Leigh Byler
• Stacey Renee Chess
• Barbara De Villiers
• Henry D Debiec, DO
• Dr. Michael J Jurenovich, D.O., PC
• Dr. Michael J. Namey, D.O., Inc
• Krystal Elliott

• Family Medicine Physician in Andover, OH
• Providers in Andover, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.