Individual provider Active NPI

Jesse E Samuel

  • Family Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1902120934
Registry record updated May 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
28005 Issued in OK
Practice address
1919 E Memorial Rd
Oklahoma City, OK 73131-1253
Phone
(405) 310-8591
Fax
(405) 330-1811
NPI assigned
Mar 19, 2010
Last updated
May 2, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2018

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 28005 OK Primary

Addresses

Primary practice location

1919 E Memorial Rd
Oklahoma City, OK 73131-1253

Mailing address

1919 E Memorial Rd
Oklahoma City, OK 73131-1253
Phone (405) 310-8591

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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

Enrollment IDStateProvider typePAC IDDetails
I20130812000353 OK Practitioner - Family Practice 3779725395 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Oklahoma College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

1919 E Memorial Rd
Oklahoma City, OK 73131-1253
Phone (405) 341-7009

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28005OKMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Oklahoma Communities Family Medicine CurrentSince Jul 1, 2013 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Mercy Hospital Oklahoma City, Inc Past Accepting new patients
Summit Medical Center Past Accepting new patients
Mercy Hospital Oklahoma City, Inc Past Accepting new patients

Locations

1919 E Memorial Rd
Oklahoma City, OK 73131
Phone (405) 341-7009

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

8325 NW Expressway
Oklahoma City, OK 73162
Phone (405) 728-8000

Interoperability endpoints

  • Direct secure messaging: jsamuel361118@directc.mercy.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1268956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525219200000",
    "number": "1902120934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 E MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731311253",
            "telephone_number": "405-310-8591",
            "fax_number": "405-330-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 E MEMORIAL RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731311253",
            "telephone_number": "405-310-8591",
            "fax_number": "405-330-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "JESSE",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-19",
        "last_updated": "2018-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "28005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.