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DR. SAMUEL SPENCER JELLISON DO
NPI 1891371373
Student in an Organized Health Care Education/Training Program in Tulsa, OK

Active since March 23, 2021PECOS Enrolled
717 S HOUSTON AVE FL 3, TULSA, OK 74127(918) 382-3535(918) 382-3559 Get Directions Write a Review

NPPES record last updated: May 22, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 22, 2026, Apr 18, 2026, Mar 23, 2021 (3 updates tracked since 2021).

About Dr. Samuel Spencer Jellison Do NPPES

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

DR. SAMUEL SPENCER JELLISON DO (NPI 1891371373) is an individual student in an organized health care education/training program in Tulsa, Oklahoma and active in the NPI registry since March 2021. He is enrolled in Medicare PECOS and is a graduate of Oklahoma State University College Of Osteopathic Medicine (2026).

NPPES Registry Identity

NPI1891371373
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. SAMUEL SPENCER JELLISONCredential: DO
Location Address717 S HOUSTON AVE FL 3Tulsa, OK 74127-9023
Mailing Address169 Ashley Avenue, Room 202 Main Hospital, Msc333Charleston, SC 29425 · (843) 792-0337 · Fax (843) 792-9319
Phone(918) 382-3535
Fax(918) 382-3559
Sole ProprietorNo
Medical School CMSOklahoma State University College Of Osteopathic MedicineGraduated 2026
Enumeration DateMarch 23, 2021
Last NPPES UpdateMay 22, 20263 updates tracked since enumeration
NPPES CertifiedMay 22, 2026
✔ NPI 1891371373 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ 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.
Also ListedRadiology · NeuroradiologyTaxonomy 2085N0700X · License 7750 (OK)
Also ListedRadiology · Diagnostic RadiologyTaxonomy 2085R0202X · License 7750 (OK)
717 S HOUSTON AVE FL 3, Tulsa, OK 74127
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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)

Dr. Samuel Spencer Jellison Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5597237412
PECOS Enrollment IDI20260611002831
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 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

REAGAN LIVINGSTON DO
Student in an Organized Health Care Education/Training Program
717 S HOUSTON AVE FL 3
TULSA, OK 74127
Osage County (918) 382-3535
DR. ZACHARY GRIFFIN DO
Internal Medicine
717 S HOUSTON AVE FL 3
TULSA, OK 74127
Osage County (918) 382-5058

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 Jellison's NPI number?

The NPI number for Samuel Jellison is 1891371373. It was assigned to this individual provider in the NPPES registry on March 23, 2021.

Where is Samuel Jellison located?

Samuel Jellison practices at 717 S Houston Ave Fl 3, Tulsa, OK 74127. The listed phone number is (918) 382-3535.

What is Samuel Jellison'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 Jellison enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Samuel Jellison was last updated on May 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.