Lisa J Samson-Fang, MD

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

360059-1205 Issued in UT

Practice address

50 N Medical Dr
Salt Lake City, UT 84132-0001

Phone

(801) 581-3501

NPI assigned

Oct 13, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment NPD
• Shriners Hospitals for Children

  • Pediatric Orthopaedic Surgery Physician
  • Salt Lake City, UT
  • NPI 1396187282
  Medicare reassignment NPD
• Ihc Health Services, Inc

  dba McKay Dee Sports Medicine

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Ogden, UT
  • NPI 1033240965
  NPD
• Ihc Health Services, Inc.

  dba St George Adolescent Partial Hospitalization

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD
• Department of Pediatrics University of Utah

  • Pediatrics Physician
  • Salt Lake City, UT
  • NPI 1679528715
  NPD (past)

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821188442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 581100",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841581100",
            "telephone_number": "801-213-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N MEDICAL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMSON-FANG",
        "first_name": "LISA",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "UT",
            "license": "360059-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Sampson, M.ED.
• Blake Patrick Sampson, M.D.
• Judith Sawaya Sampson, APRN
• Kathryn Sampson
• Sams West Inc (Sams Pharmacy 10-6686)
• Kate Keller Samson, PSYD
• Kalyani Samudra, MD
• Anita Mary Samuel, MD, MBA
• Katie Nicole Samuels, PT
• Anna Samuelson

• Developmental - Behavioral Pediatrics Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Developmental - Behavioral Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.