Individual provider Active NPI

Terry Shira Samuel, M.D.

  • Anesthesiology Physician
  • Lakewood, CO
National Provider Identifier
1972541993
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
36121 Issued in CO
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

Updated by the provider on Jun 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
013621211MedicaidCO
028998OtherCOKAISER COMMERCIAL NUMBER

Other names 1

  • Terry Shira Myers Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110128000454 CO Practitioner - Anesthesiology 4880873496 Reassigns benefits to 1 organization

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
Denver Digestive Health Specialists IncGroup PAC ID 8022090067, 17 clinicians

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 100Reported as group
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

LicenseStateTypeSpecialty
36121COMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Gastroenterology Prof LLC CurrentSince Feb 19, 2024 Accepting new patients
Denver Digestive Health Specialists Inc CurrentSince Dec 1, 2020 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.

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

Verify at the official NPI Registry.