Samuel J Byrd, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01058714A Issued in IN

Practice address

1621 Willow St
Vincennes, IN 47591-4211

Phone

(812) 882-2400

Fax

(812) 882-2422

NPI assigned

May 31, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305590400000",
    "number": "1790788081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 665",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475910665",
            "telephone_number": "812-882-2400",
            "fax_number": "812-882-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 WILLOW ST",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475914211",
            "telephone_number": "812-882-2400",
            "fax_number": "812-882-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BYRD",
        "first_name": "SAMUEL",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2011-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01058714A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "000000325459",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200475520",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Brown, MSW, LSW
• Vicki Brown, P.T.A.
• Angela M Brunt, COTA/L
• Kenneth W Buehlman, M.D.
• Elaine L Burcham, NP
• Alexia Shane Caballero, PA-C
• Heather Campbell, RN
• Bridget M Cannon
• Michael L Cantwell, M.D.
• Reynaldo A Carandang, M.D.

• Family Medicine Physician in Vincennes, IN
• Providers in Vincennes, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; 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.