Jeffrey Samelson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20010303A Issued in IN

Practice address

104 Woodland CT Ste B
Michigan City, IN 46360-7391

Phone

(219) 628-6463

Fax

(219) 628-6463

NPI assigned

Jan 26, 2006

Last updated

Mar 7, 2024By 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 3

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sacks Clinical Consulting, PCGroup PAC ID 9335320134, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Sacks Clinical Consulting, PC

  • Counseling Psychologist
  • Michigan City, IN
  • NPI 1548567241
  Medicare reassignment Care Compare group NPD
• Dunes Optical, LLC

  • Optometrist
  • Michigan City, IN
  • NPI 1306943436
  NPD (past)
• Healthpartners Medical Group, LLC

  dba HealthPartners

  • Multi-Specialty Clinic/Center
  • Michigan City, IN
  • NPI 1013014158
  NPD (past)
• Healthpartners Medical Group, LLC

  • Urgent Care Clinic/Center
  • Valparaiso, IN
  • NPI 1154564110
  NPD (past)
• Medical Group Surgery Center LLC

  dba Healthpartners Medical Group Sugery Center

  • Ambulatory Surgical Clinic/Center
  • Michigan City, IN
  • NPI 1760518617
  NPD (past)
• Virtual Consult MD LLC

  • Psychiatry Physician
  • Evansville, IN
  • NPI 1871966523
  NPD (past)

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1801866223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 E COOLSPRING AVE",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463606312",
            "telephone_number": "219-873-2964",
            "fax_number": "219-873-2933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 WOODLAND CT STE B",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463607391",
            "telephone_number": "219-628-6463",
            "fax_number": "219-628-6463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMELSON",
        "first_name": "JEFFREY",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-26",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20010303A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20010303A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000347073",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00616032",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100162900",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mohammad Salameh, DMD
• Elias Salloum, M.D
• Anna R Salyer, MS, OTR
• Justo Santos Samalio III, D.C.
• Samaritan Counseling Centers, Inc (Samaritan Counselin Centers, Inc.)
• Danny C Sardon, MD
• Anshu Kumar Saxena, PT, MS MPT(NEURO)
• Kristina Lauren Scalzitti, NURSE PRACTITIONER
• Patricia Schmidt, WHNP
• Thomas Schmittdiel, MD

• Clinical Psychologist in Michigan City, IN
• Providers in Michigan City, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.