Samuel Joseph Pullen, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2020-00356 Issued in NC

Practice address

140 Kimel Park Dr Ste 200
Winston Salem, NC 27103-6185

Phone

(336) 718-7250

Fax

(336) 718-7260

NPI assigned

Jul 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: spullen1032589@direct.novanthealth.org

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.

• St Luke'S Magic Valley Regional Medical Center LTD

  • Community/Retail Pharmacy
  • Twin Falls, ID
  • NPI 1760203921
  NPD (past)

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1689874968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 KIMEL PARK DR STE 200",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036185",
            "telephone_number": "336-718-7250",
            "fax_number": "336-718-7260"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "414 Shoup Ave W",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "833015042",
            "country_code": "US",
            "telephone_number": "208-814-9100",
            "fax_number": "208-814-9903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PULLEN",
        "first_name": "SAMUEL",
        "middle_name": "JOSEPH",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-24",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "51241",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NC",
            "license": "2020-00356",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2020-00356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689874968",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meaghan Puckett, MD
• Karly Suzanne Pugh, PT, DPT, EPC
• Raeford Theodore Pugh, MD
• Lara Puig, PHARM.D.
• Camila A Pulgar, MS
• Christian Jarrett Pulliam
• Nicholas Dane Pulliam, CRNA
• Kathleen Webb Punger, MD
• Advaita Punjala-Patel, MD
• Izabela Purcaru

• Psychiatry Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.