Shane T Sampson (NPI# 1023080116, PAC ID# 1951488766) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1023080116 |
| PAC ID by PECOS | 1951488766 |
| Professional Enrollment ID | I20080403000328 |
| Full Name | Shane T Sampson |
| Organization Legal Name | PROVIDENCE MEDICAL GROUP |
| Address |
2912 Springboro W Moraine OH 45439-1674 |
| Gender | M |
| Medical School | INDIANA UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1989 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 2860386349 |
| Number of Group Practice Members | 37 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 360133 | GRANDVIEW AND SOUTHVIEW HOSPITALS |
| 360239 | KETTERING MEDICAL CENTER - SYCAMORE |
| 360079 | KETTERING MEDICAL CENTER |
| 360051 | MIAMI VALLEY HOSPITAL |
| 360360 | SOIN MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 2912 Springboro W, Moraine, OH 45439-1674 | PROVIDENCE MEDICAL GROUP |
| Organization Legal Name | PROVIDENCE MEDICAL GROUP |
| Physicians | 50 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Theresa Kay Edwards | Nurse Practitioner | Providence Medical Group | 8701 Troy Pike, Suite 20, Huber Heights, OH 45424-1073 |
| Timothy D Webb | Family Medicine | Providence Medical Group | 4403 W Franklin St D, Bellbrook, OH 45305-2700 |
| Krista A Miller | Nurse Practitioner | Providence Medical Group | 49 E Ctr St, Farmersville, OH 45325-1110 |
| Caitlyn Frantz | Nurse Practitioner | Providence Medical Group | 6255 Chambersburg Rd, Huber Heights, OH 45424-3873 |
| Meta Lisa Howard | Nurse Practitioner | Providence Medical Group | 400 Corporate Ctr Dr, Vandalia, OH 45377-1164 |
| Kristen M Schwieterman | Nurse Practitioner | Providence Medical Group | 4353e State Route 73, Waynesville, OH 45068-8812 |
| Kevin A Carter | Family Medicine | Providence Medical Group | 38 Woodcroft Trl, Beavercreek, OH 45430-1980 |
| Mary F Sroga | Nurse Practitioner | Providence Medical Group | 1870 Dayton Germantown Pike, Germantown, OH 45327-1100 |
| James R Fisco | Family Medicine | Providence Medical Group | 70 Remick Blvd, Springboro, OH 45066-9168 |
| Barbara A Bennett | Family Medicine | Providence Medical Group | 8701 Old Troy Pike, Suite 50, Huber Heights, OH 45424-1055 |
| Street Address |
2912 SPRINGBORO W |
| City | MORAINE |
| State | OH |
| Zip | 45439-1674 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mijanou D Marretta-lewis | Nurse Practitioner | Providence Medical Group | 2912 Springboro W, Moraine, OH 45439-1674 |
| Victoria E Brookshire | Nurse Practitioner | Providence Medical Group | 2912 Springboro W, Suite 201, Moraine, OH 45439-1674 |
| Mark Stuart Jeffries | Family Medicine | Providence Medical Group | 2912 Springboro W, Suite 201, Moraine, OH 45439-1674 |
| Jeffrey Blake Gleick | Family Medicine | Providence Medical Group | 2912 Springboro W, Moraine, OH 45439-1674 |
| Edward J Kinkopf | Family Practice | Providence Medical Group | 2912 Springboro W, Suite 201a, Moraine, OH 45439-1674 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Bonnie R Parish | Clinical Social Worker | Family Service Association | 2211 Arbor Blvd, Moraine, OH 45439-1521 |
| Joanna White | Clinical Social Worker | Family Service Association | 2211 Arbor Blvd, Moraine, OH 45439-1521 |
| Cheryl E Hamant Roslund | Clinical Social Worker | Family Service Association | 2211 Arbor Blvd, Moraine, OH 45439-1521 |
| Rakesh K Gupta | Nephrology | Renal Physicians Inc | 2016 Springboro W, Moraine, OH 45439-1648 |
| Jerry E Flexman | Psychologist, Clinical | Flexman Myers Clinic LLC | 2621 Dryden Rd, Suite 202, Moraine, OH 45439-1661 |
| Katherine Myers | Psychologist, Clinical | Flexman Myers Clinic LLC | 2621 Dryden Rd, Suite 202, Moraine, OH 45439-1661 |
| Thomas H Henderson | Family Practice | Providence Medical Group | 2912 Springboro Rd W, Moraine, OH 45439-1674 |
| Emma E Garcia | Family Practice | Providence Medical Group | 2912 Springboro Rd W, Suite 201, Moraine, OH 45439-1674 |
| Patrice E Christie | Physician Assistant | Providence Medical Group | 2912 Springboro Rd W, Suite 201, Moraine, OH 45439-1674 |
| Sullivan Doumont | Physician Assistant | Providence Medical Group | 2912 Springboro Rd W, Suite 201, Moraine, OH 45439-1674 |
| Find all physicians in zip 45439 | |||
| City | MORAINE |
| Zip Code | 45439 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | MORAINE + FAMILY MEDICINE |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.