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SAMUEL MOEDJIANTO MD
NPI 1457294837
Student in an Organized Health Care Education/Training Program in Winston Salem, NC

Active since April 10, 2026PECOS Enrolled
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157(336) 716-6410 Get Directions Write a Review

NPPES record last updated: April 10, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Samuel Moedjianto Md NPPES

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

SAMUEL MOEDJIANTO MD (NPI 1457294837) is an individual student in an organized health care education/training program in Winston Salem, North Carolina and active in the NPI registry since April 2026. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1457294837
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameSAMUEL MOEDJIANTOCredential: MD
Location Address1 MEDICAL CENTER BLVDWinston Salem, NC 27157-0001
Mailing Address1 Medical Center BlvdWinston Salem, NC 27157-0001 · (336) 716-6410
Phone(336) 716-6410
Sole ProprietorYes
Enumeration DateApril 10, 2026
NPPES CertifiedApril 10, 2026
✔ NPI 1457294837 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.
1 MEDICAL CENTER BLVD, Winston Salem, NC 27157
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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)

Samuel Moedjianto 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. KATHERINE MARIE DAVIS FRANCOIS MD, MPH
Obstetrics & Gynecology
1 MEDICAL CENTER BLVD
WINSTON-SALEM, NC 27157
Forsyth County (336) 716-4039
KELLY KAITLIN ELLIOTT DPM
Student in an Organized Health Care Education/Training Program
1 MEDICAL CENTER BLVD
WINSTON SALEM, NC 27157
Forsyth County (336) 716-1203
MAYA ELENA FISHER
Student in an Organized Health Care Education/Training Program
1 MEDICAL CENTER BLVD
WINSTON SALEM, NC 27157
Forsyth County (336) 716-2011
SEBASTIAN STONE HERNANDEZ MD
Student in an Organized Health Care Education/Training Program
1 MEDICAL CENTER BLVD
WINSTON SALEM, NC 27157
Forsyth County (336) 716-2011
SAMANTHA GABRIELA ECHEVARRIA
Student in an Organized Health Care Education/Training Program
1 MEDICAL CENTER BLVD
WINSTON SALEM, NC 27157
Forsyth County (336) 716-2011
REBECCA G DUGAL
Nurse Practitioner (Family)
1 MEDICAL CENTER BLVD
WINSTON SALEM, NC 27157
Forsyth County (336) 716-2011
WILLIAM ALEXANDER BEAM MD
Student in an Organized Health Care Education/Training Program
1 MEDICAL CENTER BLVD
WINSTON SALEM, NC 27157
Forsyth County (336) 716-9253
AMY CAROL KNIGHT MS, CGC
Genetic Counselor, MS
1 MEDICAL CENTER BLVD
WINSTON SALEM, NC 27157
Forsyth County (336) 713-0327

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 Moedjianto's NPI number?

The NPI number for Samuel Moedjianto is 1457294837. It was assigned to this individual provider in the NPPES registry on April 10, 2026.

Where is Samuel Moedjianto located?

Samuel Moedjianto practices at 1 Medical Center Blvd, Winston Salem, NC 27157. The listed phone number is (336) 716-6410.

What is Samuel Moedjianto's specialty?

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

Is Samuel Moedjianto enrolled in Medicare?

Yes. Samuel Moedjianto is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Samuel Moedjianto was last updated on April 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.