Active NPI
Samsam Mohamed
- Driver
- Willmar, MN
National Provider Identifier
1972391431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- J070155118207
- Practice address
- 313 Litchfield Ave SW
Willmar, MN 56201-3352 - Phone
- (320) 894-4265
- NPI assigned
- Apr 25, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | J070155118207 | MN | Primary |
Addresses
Primary practice location
313 Litchfield Ave SW
Willmar, MN 56201-3352
Mailing address
313 Litchfield Ave SW
Willmar, MN 56201-3352
Phone (320) 894-4265
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J070155118207 | MN | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745539200000",
"number": "1972391431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "313 LITCHFIELD AVE SW",
"city": "WILLMAR",
"state": "MN",
"postal_code": "562013352",
"telephone_number": "320-894-4265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "313 LITCHFIELD AVE SW",
"city": "WILLMAR",
"state": "MN",
"postal_code": "562013352",
"telephone_number": "320-894-4265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHAMED",
"first_name": "SAMSAM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-04-25",
"last_updated": "2025-04-25",
"certification_date": "2025-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "MN",
"license": "J070155118207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willmar, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.