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SAMUEL DOUGLASS DO
NPI 1063801678
Radiology - Diagnostic Radiology in Boise, ID

Active since January 20, 2015PECOS EnrolledAccepts Medicare Assignment
1055 N CURTIS RD, BOISE, ID 83706(208) 367-2121(706) 596-6720 Get Directions Write a Review

NPPES record last updated: April 18, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Mar 6, 2025, Jul 8, 2021 (2 updates tracked since 2021).

About Samuel Douglass Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMUEL DOUGLASS DO (NPI 1063801678) is an individual diagnostic radiology provider in Boise, Idaho, licensed in Idaho (OC-0433) and active in the NPI registry since January 2015. He is enrolled in Medicare PECOS, is affiliated with St Luke's Regional Medical Center, and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1063801678
Entity TypeIndividualMale
Primary Taxonomy2085R0202X
Provider Legal NameSAMUEL DOUGLASSCredential: DO
Location Address1055 N CURTIS RDBoise, ID 83706-1309
Mailing Address877 W Main St Ste 603Boise, ID 83702-6070 · (208) 954-8070 · Fax (208) 954-8073
Phone(208) 367-2121
Fax(706) 596-6720
Sole ProprietorNo
Medical School CMSRocky Vista University College Of Osteopathic MedGraduated 2015
Enumeration DateJanuary 20, 2015
Last NPPES UpdateApril 18, 20252 updates tracked since enumeration
NPPES CertifiedApril 18, 2025
✔ NPI 1063801678 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0202X
Licenses✔ Licensed in ID · OC-0433✔ Licensed in WA · OP61322937✔ Licensed in OR · DO219310✔ Licensed in NE · 1539
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
1055 N CURTIS RD, Boise, ID 83706
Open in Google Maps ↗

Secondary Practice Locations 3

Location 19040 Fitzsimmons DrJoint Base Lewis McChord, WA 98431-1000 · Phone (253) 968-0369
Location 2300 W Hospital RdFort Gordon, GA 30905-5741 · Phone (706) 787-2175
Location 31304 Fawcett Ave Ste 100Tacoma, WA 98402-1900 · Phone (253) 761-4200

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Samuel Douglass Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6103106091
PECOS Enrollment IDI20250501002532, I20250506002959
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

3

Medicare enrollment records show Samuel Douglass reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Gem State Radiology LLP
Same address
Diagnostic Radiology
1055 N CURTIS RD
Boise, ID 83706
  • Reassigned Medicare billing, Idaho and Oregon enrollments
  • 37 clinicians in this Medicare group
NPI 1083661508 (208) 367-2161
Intermountain Medical Imaging LLC
2.4 mi
Diagnostic Radiology
927 W MYRTLE ST
Boise, ID 83702
  • Reassigned Medicare billing, Idaho enrollment
  • 37 clinicians in this Medicare group
NPI 1669423679 (208) 367-7510
University Of Utah Adult Services
287 mi
Dermatology
165 N. UNIVERSITY AVE. FARMINGTON
Farmington, UT 84025
  • Reassigned Medicare billing, Utah enrollment
  • 2,620 clinicians in this Medicare group
NPI 1649724139 (801) 213-3200

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 10

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

X-ray of chest, 1 view 71045
A chest X-ray, 1 view, is a quick, painless test that produces images of the structures within your chest, such as your heart, lungs, and blood vessels. It helps in diagnosing conditions like pneumonia, heart problems, or lung cancer. You'll stand in front of a machine that emits X-rays, which pass through your body to create the image.
95 services75 patients
X-ray of chest, 2 views 71046
A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.
47 services47 patients
X-ray of chest, 2 views 71046
A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.
39 services38 patients
X-ray of lower and sacral spine, 2-3 views 72100
An X-ray of the lower and sacral spine involves capturing images of your lower back area, including the tailbone. This procedure helps in identifying problems like fractures, infections, or deformities. 2-3 different angle views provide a comprehensive picture.
29 services29 patients
Ct scan of chest without contrast 71250
A CT scan of the chest without contrast is a non-invasive imaging procedure. It uses special X-ray equipment to produce detailed images of your chest area, including your lungs and heart. It can help diagnose conditions such as lung diseases or heart disorders. It doesn't involve any dyes or contrast agents.
28 services28 patients
Low dose ct scan of chest for lung cancer screening 71271
A low-dose CT scan of the chest is a quick, painless procedure that uses a small amount of radiation to create detailed images of your lungs. It's a key tool for early detection of lung cancer, especially for those at high risk.
23 services23 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Luke's Regional Medical Center

Acute Care Hospitals · Boise, ID
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number130006
Location190 East Bannock StreetBoise, ID 83712 · Ada County
Emergency services Birthing friendly

Saint Alphonsus Regional Medical Center

Acute Care Hospitals · Boise, ID
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number130007
Location1055 North Curtis RoadBoise, ID 83706 · Ada County
Emergency services Birthing friendly

Saint Alphonsus Medical Center - Nampa

Acute Care Hospitals · Nampa, ID
3/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number130013
Location4300 E Flamingo AveNampa, ID 83687 · Canyon County
Emergency services Birthing friendly

Saint Alphonsus Medical Center - Ontario

Acute Care Hospitals · Ontario, OR
3/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number380052
Location351 SW 9th StreetOntario, OR 97914 · Malheur County
Emergency services

St. Alphonsus Medical Center - Baker City

Critical Access Hospitals · Baker City, OR
2/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number381315
Location3325 Pocahontas RoadBaker City, OR 97814 · Baker County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83706 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.13 typical visit price
range $52.44 – $160.17
Typical copayment $20.28 (range $13.11 – $40.04)
Most-billed visit code 99203
Established Patient
$65.77 typical visit price
range $16.68 – $130.93
Typical copayment $16.44 (range $4.17 – $32.73)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MAUREEN A NEWMAN M.D.
Family Medicine (Hospice and Palliative Medicine)
1055 N CURTIS RD
BOISE, ID 83706
Ada County (208) 302-5480
JESSICA A EVERT MD
Family Medicine
1055 N CURTIS RD
BOISE, ID 83706
Ada County (208) 367-7350
KRISTIE KAES LCSW
Social Worker (Clinical)
1055 N CURTIS RD
BOISE, ID 83706
Ada County (208) 367-2121
DR. MICHEAL GEORGE ADONDAKIS MD
Radiology (Diagnostic Radiology)
1055 N CURTIS RD
BOISE, ID 83706
Ada County (208) 367-2121
JACQUELINE STEAN
Nurse Practitioner
1055 N CURTIS RD
BOISE, ID 83706
Ada County (208) 367-3221
DR. JAMES ROBERT POLK MD
Internal Medicine (Rheumatology)
1055 N CURTIS RD
BOISE, ID 83706
Ada County (208) 367-3104
MATTHEW JUDD D.O.
Emergency Medicine
1055 N CURTIS RD
BOISE, ID 83706
Ada County (208) 322-1730
IAN MICHAEL WOOD PHARM D
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
1055 N CURTIS RD
BOISE, ID 83706
Ada County (208) 367-2166

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel Douglass's NPI number?

The NPI number for Samuel Douglass is 1063801678. It was assigned to this individual provider in the NPPES registry on January 20, 2015.

Where is Samuel Douglass located?

Samuel Douglass practices at 1055 N Curtis Rd, Boise, ID 83706. The listed phone number is (208) 367-2121.

What is Samuel Douglass's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Is Samuel Douglass enrolled in Medicare?

Yes. Samuel Douglass is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Samuel Douglass's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Douglass reassigns Medicare benefits to 3 organizations: Gem State Radiology LLP (Boise, ID), Intermountain Medical Imaging LLC (Boise, ID) and University Of Utah Adult Services (Farmington, UT). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samuel Douglass's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Samuel Douglass affiliated with any hospitals?

According to CMS data, Samuel Douglass is affiliated with St Luke's Regional Medical Center, Saint Alphonsus Regional Medical Center, Saint Alphonsus Medical Center - Nampa, Saint Alphonsus Medical Center - Ontario and St. Alphonsus Medical Center - Baker City.

When was this NPI record last updated?

The NPPES record for Samuel Douglass was last updated on April 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.