Active NPI
Terry Shira Samuel, M.D.
- Anesthesiology Physician
- Lakewood, CO
National Provider Identifier
1972541993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 36121
- Practice address
- 11600 W 2ND PL
Lakewood, CO 80228-1527 - Phone
- (719) 537-0712
- NPI assigned
- Jun 3, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 36121 | CO | Primary |
Addresses
Primary practice location
11600 W 2ND PL
Lakewood, CO 80228-1527
Mailing address
10350 E Dakota Ave
Denver, CO 80247-1314
Other practice location 1
10350 E Dakota Ave
Denver, CO 80247-1314
Phone (303) 338-4545
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 013621211 | Medicaid | CO | |
| 028998 | Other | CO | KAISER COMMERCIAL NUMBER |
Other names 1
- Terry Shira Myers
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Anesthesiology
- Education
- University of Texas Medical School at Houston, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4500 E 9TH Ave
720S
Denver, CO 80220-3926
Phone (303) 355-3525
Merit-based Incentive Payment System (MIPS)
- Final score
- 74.04 of 100
- Quality
- 48.8
- Promoting interoperability
- 98
- Improvement activities
- 40
- Cost
- 66.32
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36121 | CO | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Colorado Gastroenterology Prof LLC | Current | Accepting new patients | |
| Denver Digestive Health Specialists Inc | Current | Accepting new patients |
Locations
4500 E 9th Ave
Ste 720S
Denver, CO 80220
Phone (303) 355-3525
Organizations & group practices 2
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.
-
- Gastroenterology Physician
- Denver, CO
- NPI 1447278981
-
- Gastroenterology Physician
- Denver, CO
- NPI 1396790101
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624320000000",
"number": "1972541993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10350 E DAKOTA AVE",
"city": "DENVER",
"state": "CO",
"postal_code": "802471314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11600 W 2ND PL",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "802281527",
"telephone_number": "719-537-0712"
}
],
"practiceLocations": [
{
"address_1": "10350 E Dakota Ave",
"address_purpose": "LOCATION",
"city": "Denver",
"state": "CO",
"postal_code": "802471314",
"country_code": "US",
"telephone_number": "303-338-4545",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SAMUEL",
"first_name": "TERRY",
"middle_name": "SHIRA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-03",
"last_updated": "2021-06-22",
"certification_date": "2021-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CO",
"license": "36121",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "013621211",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER COMMERCIAL NUMBER",
"identifier": "028998",
"state": "CO"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodcom/wcf/epic.community.hie/xcpdrespondinggateways",
"affiliation": "N",
"endpointDescription": "Carequality",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "10350 E Dakota Ave",
"city": "Denver",
"state": "CO",
"country_code": "US",
"postal_code": "802471314",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "TERRY",
"last_name": "MYERS",
"middle_name": "SHIRA",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Lakewood, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.