DR. SAMUEL JOHN KJOME MD
NPI 1336110600
Family Medicine in Apo, AE
About Dr. Samuel John Kjome Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. SAMUEL JOHN KJOME MD (NPI 1336110600) is an individual family medicine provider in Apo, AE, licensed in Minnesota (59459) and active in the NPI registry since January 2006. He is enrolled in Medicare PECOS, is affiliated with Park Nicollet Methodist Hospital, and maintains a secondary practice location in St Louis Park.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 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
Dr. Samuel John Kjome 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.
Medicare Billing Reassignments
2Medicare enrollment records show Samuel Kjome reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Waite Park, MN 56387
- Reassigned Medicare billing, Minnesota enrollment
- 2,274 clinicians in this Medicare group
St Louis Park, MN 55416
- Reassigned Medicare billing, Minnesota enrollment
- Medicare enrollment name: Park Nicollet Clinic
- 2,527 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.
Areas of Expertise CMS Part B claims 3
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.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Park Nicollet Methodist Hospital
Acute Care Hospitals · Saint Louis Park, MNFrequently 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 Kjome's NPI number?
The NPI number for Samuel Kjome is 1336110600. It was assigned to this individual provider in the NPPES registry on January 27, 2006.
Where is Samuel Kjome located?
Samuel Kjome practices at 48 Medical Group / Sgop Unit 5210 Box 230, Apo, AE 09461.
What is Samuel Kjome's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Samuel Kjome enrolled in Medicare?
Yes. Samuel Kjome 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 Kjome's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Kjome reassigns Medicare benefits to 2 organizations: Group Health, Inc. (Waite Park, MN) and Park Nicollet Methodist Hospital (St Louis Park, MN). 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 Kjome's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Samuel Kjome affiliated with any hospitals?
According to CMS data, Samuel Kjome is affiliated with Park Nicollet Methodist Hospital.
When was this NPI record last updated?
The NPPES record for Samuel Kjome was last updated on June 10, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Dr. Samuel John Kjome, MD · NPI 1336110600
Family Medicine physician in Apo, AE. Individual provider, active in the CMS NPPES registry since January 27, 2006.
## Identity
- **NPI:** 1336110600 (Entity type: Individual)
- **Enumerated:** January 27, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** 59459 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 48 MEDICAL GROUP / SGOP UNIT 5210, BOX 230, Apo, AE 09461
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Group Health, Inc. (NPI 1457836454, Waite Park, MN); Park Nicollet Methodist Hospital (NPI 1194113217, St Louis Park, MN) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Minnesota Medical School, class of 2004
## Record status
- **NPPES last updated:** June 10, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1336110600) · Data from the CMS NPPES public registry.