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BLAIN ANTHONY SAMUELSON MD
NPI 1154011567
Student in an Organized Health Care Education/Training Program in Davenport, IA

Active since May 09, 2023PECOS Enrolled
1345 W CENTRAL PARK AVE, DAVENPORT, IA 52804(563) 421-4400 Get Directions Write a Review

NPPES record last updated: June 26, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Blain Anthony Samuelson Md NPPES

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

BLAIN ANTHONY SAMUELSON MD (NPI 1154011567) is an individual student in an organized health care education/training program in Davenport, Iowa and active in the NPI registry since May 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1154011567
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameBLAIN ANTHONY SAMUELSONCredential: MD
Location Address1345 W CENTRAL PARK AVEDavenport, IA 52804-1844
Mailing Address1345 W Central Park AveDavenport, IA 52804-1844 · (563) 421-4400
Phone(563) 421-4400
Sole ProprietorYes
Enumeration DateMay 9, 2023
Last NPPES UpdateJune 26, 2023
NPPES CertifiedJune 26, 2023
✔ NPI 1154011567 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1345 W CENTRAL PARK AVE, Davenport, IA 52804
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Blain Anthony Samuelson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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. JESICAH ELISABETH AMBRISCO DO
Family Medicine
1345 W CENTRAL PARK AVE
DAVENPORT, IA 52804
Scott County (563) 421-4400
CAROLINE SIDLINGER DNP
Nurse Practitioner (Family)
1345 W CENTRAL PARK AVE
DAVENPORT, IA 52804
Scott County (563) 421-4400
THANG LUONG D.O.
Family Medicine
1345 W CENTRAL PARK AVE
DAVENPORT, IA 52804
Scott County (563) 421-4400
DAILEN MARIE FOLKEDAHL DO
Family Medicine
1345 W CENTRAL PARK AVE
DAVENPORT, IA 52804
Scott County (563) 421-4400
JOSHUA CARPENTER M.D.
Family Medicine
1345 W CENTRAL PARK AVE
DAVENPORT, IA 52804
Scott County (563) 421-4400
ROSS BURANDT
Student in an Organized Health Care Education/Training Program
1345 W CENTRAL PARK AVE
DAVENPORT, IA 52804
Scott County (563) 421-4400
STEPHANIE ANNE MCMILLAN DO
Student in an Organized Health Care Education/Training Program
1345 W CENTRAL PARK AVE
DAVENPORT, IA 52804
Scott County (563) 421-4400
DR. BRADLEY W JOHNSON D.O
Family Medicine
1345 W CENTRAL PARK AVE
DAVENPORT, IA 52804
Scott County (563) 421-4400

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 Blain Samuelson's NPI number?

The NPI number for Blain Samuelson is 1154011567. It was assigned to this individual provider in the NPPES registry on May 9, 2023.

Where is Blain Samuelson located?

Blain Samuelson practices at 1345 W Central Park Ave, Davenport, IA 52804. The listed phone number is (563) 421-4400.

What is Blain Samuelson's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Blain Samuelson enrolled in Medicare?

Yes. Blain Samuelson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Blain Samuelson was last updated on June 26, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.