Theodore G. Sample Jr., M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

112824 Issued in MO

Practice address

621 S. New Ballas Road
Suite 6009-B
St. Louis, MO 63141

Phone

(314) 251-6598

Fax

(314) 251-7990

NPI assigned

Oct 2, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Enrolled in MO, CA, OH3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: theodore.sample@direct.stjohnhealthsystem.com
• Direct secure messaging: tsample15422@enloedirect.org

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.

• Mercy Clinic Springfield Communities

  • Family Medicine Physician
  • Springfield, MO
  • NPI 1245277631
  Medicare reassignment NPD
• Enloe Medical Center

  dba Enloe Trauma & Surgery Clinic

  • Surgery Physician
  • Chico, CA
  • NPI 1477975613
  Medicare reassignment NPD
• Mercy Health Physicians-North LLC

  • Family Medicine Physician
  • Toledo, OH
  • NPI 1609000769

  Pediatrics

  Medicare reassignment NPD
• Valley Children's Medical Group

  • Pediatrics Physician
  • Modesto, CA
  • NPI 1437555265
  Medicare reassignment NPD
• Mercy Clinic Springfield Communities

  dba Mercy Clinic Family Medicine-Willow Springs

  • Rural Health Clinic/Center
  • Willow Springs, MO
  • NPI 1972771657
  NPD
• Enloe Medical Center

  dba Enloe Op Center Pharmacy

  • Community/Retail Pharmacy
  • Chico, CA
  • NPI 1912949538
  NPD
• Mercy Health Physicians - North, LLC

  dba Mercy Health - Perrysburg Podiatry

  • Customized Equipment (DME)
  • Perrysburg, OH
  • NPI 1992358766
  NPD
• Mercy Hospital Springfield

  • General Acute Care Hospital
  • Springfield, MO
  • NPI 1578504056
  NPD (past)
• Mercy Hospitals East Communities

  dba Mercy Hospital St Louis

  • Rehabilitation Hospital Unit
  • Saint Louis, MO
  • NPI 1235236779
  NPD (past)
• Emanuel Medical Center, Inc.

  • General Acute Care Hospital
  • Turlock, CA
  • NPI 1174615330
  NPD (past)
• Enloe Medical Center

  dba Enloe Cardiology Services

  • Cardiovascular Disease Physician
  • Chico, CA
  • NPI 1720099328
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922191584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S. NEW BALLAS ROAD",
            "address_2": "SUITE 6009-B",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "314-251-6598",
            "fax_number": "314-251-7990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S. NEW BALLAS ROAD",
            "address_2": "SUITE 6009-B",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "314-251-6598",
            "fax_number": "314-251-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPLE",
        "first_name": "THEODORE",
        "middle_name": "G.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "112824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209750702",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samones Courier&Transport Services
• Andres Samos
• Hanish Sampath Kumar
• Kruthika Sampathgiri, MD
• Mallory C Sample, MSW, LCSW
• Adam Robert Sampson, PA
• Dawn R Sampson, MS, CCC/SLP
• Monisha K Sampson
• Sams East Inc (Sams Pharmacy 10-8205)
• Sams East Inc (Sams Pharmacy 10-4741)

• Pediatrics Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.