Walter Vincent Samuel, D.D.S.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

2605 64TH Ave S
Fargo, ND 58104-7403

Phone

(701) 799-4381

NPI assigned

May 26, 2009

Sex

Male

Sole proprietor

Yes

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 ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243296000000",
    "number": "1891920542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 64TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047403",
            "telephone_number": "701-799-4381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 64TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047403",
            "telephone_number": "701-799-4381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "WALTER",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-26",
        "last_updated": "2009-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casey Samis
• Kyle Sample
• Jerome M Sampson, MD
• Pamela Marie Samson, PHD
• Tessa Samson
• Lisa Andrea Samuelson, OTR
• Paige Rae Samuelson, PT, DPT
• Wayne D Samuelson, PHD
• Mohamed Sanaullah, MD
• Cyd Sanchez

• Student in an Organized Health Care Education/Training Program in Fargo, ND
• Providers in Fargo, ND by specialty
• Student in an Organized Health Care Education/Training Program in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2009; 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.