Individual provider Active NPI

Samuel Peter Mackoff, MD

  • General Practice Physician
  • Houston, TX
National Provider Identifier
1811577596
Registry record updated Sep 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
V2151 Issued in TX
Practice address
6411 Fannin St
Houston, TX 77030-1501
Phone
(713) 500-6526
NPI assigned
Apr 8, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X V2151 TX
General Practice Physician 208D00000X V2151 TX Primary

Addresses

Primary practice location

6411 Fannin St
Houston, TX 77030-1501

Mailing address

1133 John Freeman Blvd Ste Jjls80
Houston, TX 77030-2809

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20240929000167 TX Practitioner - General Practice 4486185683 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Physicians CurrentSince Jul 22, 2024 Accepting new patients
Ut Physicians Internal Medicine CurrentSince Jul 22, 2024 Accepting new patients
Memorial Hermann Health System Past Accepting new patients
University of Texas Health Science Center at Houston PastSince Apr 1, 2021 Accepting new patients

Locations

2800 S Macgregor Way
Houston, TX 77021
Phone (713) 741-5000

6410 Fannin St
Ste 500
Houston, TX 77030
Phone (713) 500-5714

6410 Fannin St
#135
Houston, TX 77030

6411 Fannin St
Houston, TX 77030
Phone (713) 500-6200

6431 Fannin St
#1134
Houston, TX 77030
Phone (713) 500-6525

Interoperability endpoints

  • Direct secure messaging: samuel.mackoff.1@8363.direct.athenahealth.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1617840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1811577596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 JOHN FREEMAN BLVD STE JJLS80",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6411 FANNIN ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301501",
            "telephone_number": "713-500-6526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKOFF",
        "first_name": "SAMUEL",
        "middle_name": "PETER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-08",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "V2151",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "V2151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.