SAMUEL WOLDEMICHAEL
NPI 1124637863
Counselor - Professional in Hyattsville, MD
About Samuel Woldemichael NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMUEL WOLDEMICHAEL (NPI 1124637863) is an individual professional provider in Hyattsville, Maryland, licensed in Maryland (LC10486) and active in the NPI registry since July 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2016).
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
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 Woldemichael 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.
Medicare Billing Reassignment
Medicare enrollment records show Samuel Woldemichael reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Columbia, MD 21045
- Reassigned Medicare billing, Maryland enrollment
- 29 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
W HYATTSVILLE, MD 20782
HYATTSVILLE, MD 20782
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 Woldemichael's NPI number?
The NPI number for Samuel Woldemichael is 1124637863. It was assigned to this individual provider in the NPPES registry on July 29, 2020.
Where is Samuel Woldemichael located?
Samuel Woldemichael practices at 3415 Hamilton St Ste 9, Hyattsville, MD 20782. The listed phone number is (301) 538-5659.
What is Samuel Woldemichael's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Samuel Woldemichael enrolled in Medicare?
Yes. Samuel Woldemichael 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 organization bills Medicare for Samuel Woldemichael's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Woldemichael reassigns Medicare benefits to Optum Behavioral Care Of North Carolina, PC (Columbia, MD). The 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 Woldemichael's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Samuel Woldemichael was last updated on July 29, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years 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.
# Samuel Woldemichael · NPI 1124637863
Professional provider in Hyattsville, Maryland. Individual provider, active in the CMS NPPES registry since July 29, 2020.
## Identity
- **NPI:** 1124637863 (Entity type: Individual)
- **Enumerated:** July 29, 2020
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** LC10486 (Maryland)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 3415 HAMILTON ST STE 9, Hyattsville, MD 20782-3953
- **Phone:** (301) 538-5659
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Optum Behavioral Care Of North Carolina, PC (NPI 1518732833, Columbia, MD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2016
## Record status
- **NPPES last updated:** July 29, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1124637863) · Data from the CMS NPPES public registry.