Samuel L. Zuckerman, M.D.

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

License

M-15488 Issued in ID

Practice address

Mountain Neonatology LLC
3100 Channing Way
Idaho Falls, ID 83404-7533

Phone

(602) 346-7013

NPI assigned

Apr 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 5

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: szuckerman913878@ahs.direct-ci.com

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.

• Baylor College of Medicine

  • Pediatrics Physician
  • San Antonio, TX
  • NPI 1285079764
  Medicare reassignment NPD
• Bsa Physicians Group Inc

  • Internal Medicine Physician
  • Amarillo, TX
  • NPI 1457696916
  Medicare reassignment NPD
• Children'S Physician Services of South Texas

  • Plastic Surgery Physician
  • Corpus Christi, TX
  • NPI 1568658227
  Medicare reassignment NPD
• Texas Tech University Health Sciences Center Amarillo

  • Family Medicine Physician
  • Amarillo, TX
  • NPI 1013942150
  Medicare reassignment NPD
• Bsa Physicians Group Inc

  • Family Medicine Physician
  • Amarillo, TX
  • NPI 1144668765
  NPD
• Children'S Physician Services of South Texas

  • Pediatrics Physician
  • Corpus Christi, TX
  • NPI 1801856786
  NPD
• Texas Tech University Health Sciences Center

  • Pharmacy
  • Lubbock, TX
  • NPI 1609810977
  NPD
• Texas Tech University Health Sciences Center Amarillo

  • Pediatrics Physician
  • Amarillo, TX
  • NPI 1386675940
  NPD
• Pediatric Intensive Care of San Antonio

  • Pediatric Critical Care Medicine Physician
  • San Antonio, TX
  • NPI 1558542852
  NPD (past)
• Texas Institute of Medicine and Surgery

  • Transplant Surgery Physician
  • San Antonio, TX
  • NPI 1376501668

  Pediatric Critical Care Medicine

  NPD (past)

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1831156595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047533",
            "telephone_number": "210-737-4928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MOUNTAIN NEONATOLOGY LLC",
            "address_2": "3100 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047533",
            "telephone_number": "602-346-7013"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 S Coulter St",
            "address_purpose": "LOCATION",
            "city": "Amarillo",
            "state": "TX",
            "postal_code": "791061786",
            "country_code": "US",
            "telephone_number": "806-414-9800",
            "fax_number": "806-354-5689",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "315 N San Saba Ste 1135",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782073255",
            "country_code": "US",
            "telephone_number": "210-737-4928",
            "fax_number": "210-704-4520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZUCKERMAN",
        "first_name": "SAMUEL",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "TX",
            "license": "J9854",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "TX",
            "license": "J9854",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "ID",
            "license": "M-15488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132776910",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200102900 A",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33787336",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132776912",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132776911",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zoe Interventional Pain Management, LLC
• Holly Zoe, MD
• Alan L. Zohner, PH.D.
• Jaxson P Zohner, PMHNP-BC
• Ronald M. Zohner, M.D.

• Pediatric Critical Care Medicine Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Pediatric Critical Care Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; 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.