Samuel Jacob Watson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

46559 Issued in KY

Practice address

1640 Bryan Station Rd Ste 1
Lexington, KY 40505-2144

Phone

(859) 288-2425

Fax

(859) 721-3918

NPI assigned

Jul 3, 2010

Sex

Male

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 3

Medicare fee-for-service enrollment

Enrolled in KY

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samuel.watson.1@32600.direct.athenahealth.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.

• Healthfirst Bluegrass Inc

  • Federally Qualified Health Center (FQHC)
  • Lexington, KY
  • NPI 1114932514
  Medicare reassignment NPD
• Healthfirst Bluegrass Inc.

  • Federally Qualified Health Center (FQHC)
  • Lexington, KY
  • NPI 1447997044
  NPD

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

{
    "created_epoch": "1278115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678665600000",
    "number": "1881906022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "496 SOUTHLAND DR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405031827",
            "telephone_number": "859-288-2392",
            "fax_number": "859-721-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 BRYAN STATION RD STE 1",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405052144",
            "telephone_number": "859-288-2425",
            "fax_number": "859-721-3918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "SAMUEL",
        "middle_name": "JACOB",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-03",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "46559",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATION",
            "identifier": "108752",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100253290",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENTUCKY BOARD OF MEDICAL LICENSURE",
            "identifier": "46559",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelby Jeneise Watkins
• Darren Alex Watson, CRNA
• Demetruis Renee Watson
• Laura Watson, M.D.
• Mary Elizabeth Watson, PA
• Bethany Cooper Watt, M.S.
• Grant Watt, CRNA
• Rebekah Watt, LCADC
• Shelby Lynn Watt
• Mariesha D Watters, LMT

• Pediatrics Physician in Lexington, KY
• Providers in Lexington, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; 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.