Samuel Hally, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

65699 Issued in ID

Practice address

1346 Cimarron CT
Middleton, ID 83644-5894

Phone

(208) 695-8001

NPI assigned

Sep 17, 2020

Last updated

Sep 17, 2020By 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

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• CS Pacs 3 Northwest, LLC

  • Hospitalist Physician
  • Puyallup, WA
  • NPI 1811752066
  Medicare reassignment NPD
• Molina Healthcare of Washington, Inc

  • Family Medicine Physician
  • Everett, WA
  • NPI 1912235060
  Medicare reassignment NPD
• Wa Pacs 2 PC

  • Hospitalist Physician
  • Tacoma, WA
  • NPI 1144706532
  Medicare reassignment NPD
• Washington Pac Services PC

  • Hospitalist Physician
  • Spokane, WA
  • NPI 1336678168
  Medicare reassignment NPD
• Molina Healthcare of Washington, Inc

  • Family Medicine Physician
  • Bothell, WA
  • NPI 1659897163
  NPD

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1982210795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1346 CIMARRON CT",
            "city": "MIDDLETON",
            "state": "ID",
            "postal_code": "836445894",
            "telephone_number": "208-695-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1346 CIMARRON CT",
            "city": "MIDDLETON",
            "state": "ID",
            "postal_code": "836445894",
            "telephone_number": "208-695-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLY",
        "first_name": "SAMUEL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "65699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beverlee K Furner, NP
• Aries J Ganir, DMD
• Sarah E Grever, NA
• Katherine Grijalva
• Julie Halatyn
• Jeffrey K Harris, DC
• Rustin G Hawker, DDS
• Brian T Heaton, PT
• Angela B Hemry
• Andrew Jason Hickman

• Family Nurse Practitioner in Middleton, ID
• Providers in Middleton, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.