SAMUEL LYNN SOUTHAM MD
NPI 1104868850
Radiology - Diagnostic Radiology in Provo, UT

Active since June 10, 2006PECOS EnrolledAccepts Medicare Assignment
1034 N 500 W, PROVO, UT 84604(801) 357-7850(801) 357-7626 Get Directions Write a Review

NPPES record last updated: June 10, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Samuel Lynn Southam Md NPPES

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

SAMUEL LYNN SOUTHAM MD (NPI 1104868850) is an individual diagnostic radiology provider in Provo, Utah, licensed in New Mexico (2005-0536) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS, is affiliated with Utah Valley Hospital, and is a graduate of University Of Colorado School Of Medicine, Denver (2003).

NPPES Registry Identity

NPI1104868850
Entity TypeIndividualMale
Primary Taxonomy2085R0202X
Provider Legal NameSAMUEL LYNN SOUTHAMCredential: MD
Location Address1034 N 500 WProvo, UT 84604-3380
Mailing Address1034 N 500 WProvo, UT 84604-3380 · (801) 357-7850 · Fax (801) 357-7626
Fax(801) 357-7626
Sole ProprietorNo
Medical School CMSUniversity Of Colorado School Of Medicine, DenverGraduated 2003
Enumeration DateJune 10, 2006
Last NPPES UpdateJune 10, 2021
NPPES CertifiedJune 10, 2021
NPI 1104868850 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 NM · 2005-0536 Licensed in UT · 12285899-1205
Definition

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

1034 N 500 W, Provo, UT 84604

Other Identifiers 1

Medicaid76673855NM

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Samuel Lynn Southam Md 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 ID7416954474
PECOS Enrollment IDI20210806002589
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.

Areas of Expertise CMS Part B claims 48

Services this provider delivered to Medicare fee-for-service patients, from the 2024 & 2026 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.
384 services353 patients
Ct scan of abdomen and pelvis with contrast 74177
A CT scan of the abdomen and pelvis with contrast is an imaging procedure. A special dye, called contrast, is used to make certain areas more visible. This can help identify issues such as infections, tumors, or other abnormalities. The procedure is painless and usually takes about 30 minutes.
204 services200 patients
Ct scan of blood vessels of chest with contrast 71275
A CT scan of the chest with contrast is a non-invasive imaging test. It uses X-rays and a special dye to get detailed images of your blood vessels in the chest. This helps in diagnosing conditions related to heart and lungs.
108 services108 patients
Ct scan head or brain without contrast 70450
A CT scan of the head or brain without contrast is a non-invasive imaging procedure. It uses X-rays to create detailed pictures of your brain, skull, and other structures inside your head. It helps to detect conditions like strokes, tumors, or injuries. No dye (contrast) is used in this test.
103 services98 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.
86 services84 patients
Mri scan of leg joint without contrast 73721
An MRI scan of your leg joint is a non-invasive procedure that uses magnetic fields and radio waves to create detailed images of the structures within your leg. This helps doctors diagnose or monitor conditions without using contrast dye.
84 services80 patients

Hospital Affiliations CMS Care Compare 5

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

Utah Valley Hospital

Acute Care Hospitals · Provo, UT
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number460001
Location1034 North 500 WestProvo, UT 84604 · Utah County
Emergency services Birthing friendly

American Fork Hospital

Acute Care Hospitals · American Fork, UT
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number460023
Location170 North 1100 EastAmerican Fork, UT 84003 · Utah County
Emergency services Birthing friendly

Park City Hospital

Acute Care Hospitals · Park City, UT
5/5 CMS rating
OwnershipProprietary
CMS Certification Number460057
Location900 Round Valley DrivePark City, UT 84060 · Summit County
Emergency services Birthing friendly

Spanish Fork Hospital

Acute Care Hospitals · Spanish Fork, UT
OwnershipVoluntary non-profit - Private
CMS Certification Number460062
Location765 East Market Place DriveSpanish Fork, UT 84660 · Utah County
Emergency services Birthing friendly

San Juan Hospital

Critical Access Hospitals · Monticello, UT
OwnershipVoluntary non-profit - Other
CMS Certification Number461308
Location380 West 100 NorthMonticello, UT 84535 · San Juan County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84604 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
$84.41 typical visit price
range $54.34 – $166.03
Typical copayment $21.10 (range $13.58 – $41.50)
Most-billed visit code 99203
Established Patient
$68.01 typical visit price
range $17.23 – $135.20
Typical copayment $17.00 (range $4.30 – $33.80)
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.

Preventive Medicine (Undersea and Hyperbaric Medicine)
1034 N 500 W
PROVO, UT 84604
Nurse Practitioner (Family)
1034 N 500 W
PROVO, UT 84604
Nurse Practitioner
1034 N 500 W
PROVO, UT 84604
Radiology (Diagnostic Radiology)
1034 N 500 W
PROVO, UT 84604
Radiology (Diagnostic Radiology)
1034 N 500 W
PROVO, UT 84604
Radiology (Diagnostic Radiology)
1034 N 500 W
PROVO, UT 84604
Radiology (Diagnostic Radiology)
1034 N 500 W
PROVO, UT 84604
Emergency Medicine (Emergency Medical Services)
1034 N 500 W
PROVO, UT 84604

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1104868850, enumerated as an "individual" on June 10, 2006.

The provider is located at 1034 N 500 W PROVO, UT 84604 and the phone number is (801) 357-7850.

Radiology with taxonomy code 2085R0202X and a focus in Diagnostic Radiology.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.

Samuel Southam is affiliated with: UTAH VALLEY HOSPITAL, AMERICAN FORK HOSPITAL, PARK CITY HOSPITAL, SPANISH FORK HOSPITAL and SAN JUAN HOSPITAL.