Samantha P Bostrom, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

327457-1205 Issued in UT

Practice address

1477 North 2000 West
Suite C
Clinton, UT 84015-8213

Phone

(801) 774-8888

Fax

(801) 825-8519

NPI assigned

May 16, 2007

Last updated

Aug 12, 2015By 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

Other identifiers 1

Other names 1

• Samantha N Pike Bostrom Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1881801579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1477 NORTH 2000 WEST",
            "address_2": "SUITE C",
            "city": "CLINTON",
            "state": "UT",
            "postal_code": "840158213",
            "telephone_number": "801-774-8888",
            "fax_number": "801-825-8519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1477 NORTH 2000 WEST",
            "address_2": "SUITE C",
            "city": "CLINTON",
            "state": "UT",
            "postal_code": "840158213",
            "telephone_number": "801-774-8888",
            "fax_number": "801-825-8519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSTROM",
        "first_name": "SAMANTHA",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "327457-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D2612",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "PIKE BOSTROM",
            "middle_name": "N",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Pediatrics Physician in Clinton, UT
• Providers in Clinton, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.