NPIMap

Individual provider Active NPI

Michael Sampson, MD

  • Family Medicine Physician
  • Grand Marais, MN
National Provider Identifier
1851483515
Registry record updated Dec 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
29409 Issued in MN
Practice address
513 5TH Ave W
Grand Marais, MN 55604-3017
Phone
(218) 387-2330
Fax
(218) 387-1278
NPI assigned
Sep 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 29409 MN Primary

Addresses

Primary practice location

513 5TH Ave W
Grand Marais, MN 55604-3017

Mailing address

513 5TH Ave W
Grand Marais, MN 55604-3017
Phone (218) 387-2330

Other identifiers 2

IdentifierTypeStateIssuer
69144COOtherMNBCBS
536253900MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091014000145 MN Practitioner - Family Practice 4981652450 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sawtooth Mountain Clinic IncGroup PAC ID 8224940010, 13 clinicians

Practice addresses (Care Compare)

513 5TH Ave W
Grand Marais, MN 55604-3017
Phone (218) 387-2330

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County Hospital District Past Accepting new patients
The Duluth Clinic, LTD. PastSince Jun 29, 2015 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: msampson815143@direct.ochin.org

Organizations & group practices 3

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.

Hospital & facility affiliations 29

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325030400000",
    "number": "1851483515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 5TH AVE W",
            "city": "GRAND MARAIS",
            "state": "MN",
            "postal_code": "556043017",
            "telephone_number": "218-387-2330",
            "fax_number": "218-387-1278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 5TH AVE W",
            "city": "GRAND MARAIS",
            "state": "MN",
            "postal_code": "556043017",
            "telephone_number": "218-387-2330",
            "fax_number": "218-387-1278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPSON",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2011-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "29409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "69144CO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "536253900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Marais, MN

Sources for this page

Verify at the official NPI Registry.