Individual provider Active NPI

Amelia Samuelson, PA-C

  • Physician Assistant
  • Springfield, OH
National Provider Identifier
1780298570
Registry record updated Aug 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.006358RX Issued in OH
Practice address
30 W McCreight Ave Ste 106
Springfield, OH 45504-1853
Phone
(937) 523-9820
Fax
(937) 523-9829
NPI assigned
Aug 31, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.006358RX OH Primary

Addresses

Primary practice location

30 W McCreight Ave Ste 106
Springfield, OH 45504-1853

Mailing address

30 W McCreight Ave Ste 106
Springfield, OH 45504-1853
Phone (937) 523-9820

Other practice location 1

1000 McKinley Park Dr
Marion, OH 43302-6399
Phone (740) 383-8747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210323002774 OH Practitioner - Physician Assistant 1052728896 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Carmel Healthproviders Two LLCGroup PAC ID 6608828447, 222 clinicians

Practice addresses (Care Compare)

6001 E Broad St
Mount Carmel Palliative Care
Columbus, OH 43213-1502
Phone (614) 234-6000

85 McNaughten Rd
Columbus, OH 43213-5111
Phone (614) 627-2000

Hospital & facility affiliations

  • Mount Carmel East & West Hospital, Columbus, OH, CCN 360035

Merit-based Incentive Payment System (MIPS)

Final score
79.44 of 100Reported as group
Quality
75.57
Promoting interoperability
79
Improvement activities
40
Cost
73.41

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.006358RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Carmel Healthproviders Two LLC CurrentSince Jan 9, 2023 Accepting new patients

Locations

7901 Diley Rd
Ste 140
Canal Winchester, OH 43110
Phone (614) 920-3410

85 McNaughten Rd
Ste 200
Columbus, OH 43213
Phone (614) 759-1186

6001 E Broad St
Columbus, OH 43213
Phone (614) 224-6420

6150 E Broad St
Columbus, OH 43213
Phone (614) 546-4400

85 McNaughten Rd
Ste 300
Columbus, OH 43213
Phone 61462720006

1945 Newark Granville Rd
Granville, OH 43023
Phone (614) 627-1870

5300 N Meadows Dr
Ste 280
Grove City, OH 43123
Phone (614) 234-8860

4674 Britton Pkwy
Ste 2000
Hilliard, OH 43026

7100 Graphics Way
Ste 2400
Lewis Center, OH 43035
Phone (740) 953-4100

136 E High St
London, OH 43140
Phone (740) 845-0000

477 Cooper Rd
Ste 200
Westerville, OH 43081
Phone (614) 459-7676

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.

Hospital & facility affiliations 2

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": "1598832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1780298570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 W MCCREIGHT AVE STE 106",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455041853",
            "telephone_number": "937-523-9820",
            "fax_number": "937-523-9829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 W MCCREIGHT AVE STE 106",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455041853",
            "telephone_number": "937-523-9820",
            "fax_number": "937-523-9829"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 McKinley Park Dr",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "OH",
            "postal_code": "433026399",
            "country_code": "US",
            "telephone_number": "740-383-8747",
            "fax_number": "740-382-6469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "AMELIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-31",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.006358RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OH

Sources for this page

Verify at the official NPI Registry.