Heather Marie Samuelson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME124557 Issued in FL

Practice address

302 W Fletcher Ave
Tampa, FL 33612

Phone

(813) 272-6240

NPI assigned

May 27, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MCR Health IncGroup PAC ID 7214847995, 132 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: heather.samuelson.1@11352.direct.athenahealth.com

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.

• MCR Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Parrish, FL
  • NPI 1255376000
  Medicare reassignment Care Compare group NPD
• MCR Health, Inc.

  • Non-Pharmacy Dispensing Site
  • Bradenton, FL
  • NPI 1821878745
  NPD
• MCR Health, Inc.

  • Family Medicine Physician
  • Bradenton, FL
  • NPI 1730115882

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1306454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581897600000",
    "number": "1710270426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 8TH AVE W STE 101",
            "city": "PALMETTO",
            "state": "FL",
            "postal_code": "342214737",
            "telephone_number": "941-776-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W FLETCHER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33612",
            "telephone_number": "813-272-6240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "HEATHER",
        "middle_name": "MARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-27",
        "last_updated": "2020-02-17",
        "certification_date": "2020-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME124557",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME124557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtland Reade Samuels, MD
• David J Samuels, MD
• Shaniqua Samuels, RN
• Michaela Samuelsen
• Ashley Michelle Samuelsohn, DO
• Leyla Samur, RN
• Indiana San Emeterio Perez, RBT-20-143931
• San Jose Alf, Inc.
• Daniela San Yee Gomez
• Sana Mente Counseling LLC

• Internal Medicine Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.