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THEODORE G. SAMPLE JR. M.D.
NPI 1922191584
Pediatrics in St. Louis, MO

Active since October 02, 2006PECOS Enrolled
621 S. NEW BALLAS ROAD, SUITE 6009-B, ST. LOUIS, MO 63141(314) 251-6598(314) 251-7990 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Theodore G. Sample Jr. M.d. NPPES

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

THEODORE G. SAMPLE JR. M.D. (NPI 1922191584) is an individual pediatrics provider in St. Louis, Missouri, licensed in Missouri (112824) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1922191584
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameTHEODORE G. SAMPLE JR.Credential: M.D.
Location Address621 S. NEW BALLAS ROAD, SUITE 6009-BSt. Louis, MO 63141
Mailing Address621 S. New Ballas Road, Suite 6009-bSt. Louis, MO 63141 · (314) 251-6598 · Fax (314) 251-7990
Phone(314) 251-6598
Fax(314) 251-7990
Sole ProprietorNo
Enumeration DateOctober 2, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1922191584 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in MO · 112824
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
621 S. NEW BALLAS ROAD, St. Louis, MO 63141
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Other Identifiers 1

Medicare UPINF23224

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Theodore G. Sample Jr. M.d. 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.

Medicare Billing Reassignments

4

Medicare enrollment records show Theodore Sample reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mercy Clinic Springfield Communities
187 mi
Family Medicine
3231 S NATIONAL AVE STE 220
Springfield, MO 65807
  • Reassigned Medicare billing, Missouri enrollment
  • 1,565 clinicians in this Medicare group
NPI 1245277631 (855) 420-7900
Mercy Health Physicians-North LLC
419 mi
Family Medicine
2200 JEFFERSON AVE
Toledo, OH 43604
  • Reassigned Medicare billing, Ohio enrollment
  • 457 clinicians in this Medicare group
NPI 1609000769 (419) 871-6359
Valley Children's Medical Group
1,657 mi
Pediatrics
1524 MCHENRY AVE, SUITE 550
Modesto, CA 95350
  • Reassigned Medicare billing, California enrollment
  • Medicare enrollment name: Valley Childrens Medical Group
  • 387 clinicians in this Medicare group
NPI 1437555265 (559) 353-5010
Enloe Medical Center
1,679 mi
Surgery
1600 ESPLANADE, SUITE C
Chico, CA 95926
  • Reassigned Medicare billing, California enrollment
  • 184 clinicians in this Medicare group
NPI 1477975613 (530) 332-7300

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63141 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$86.32 typical visit price
range $55.65 – $169.38
Typical copayment $21.58 (range $13.91 – $42.34)
Most-billed visit code 99203
Established Patient
$98.37 typical visit price
range $17.76 – $137.92
Typical copayment $24.59 (range $4.44 – $34.48)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

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

RONALD E. HAAKE D.O.
Internal Medicine (Critical Care Medicine)
621 S. NEW BALLAS ROAD, SUITE 4006-B
ST. LOUIS, MO 63141
St. Louis County (314) 251-6486
MERCY CLINIC CHILDREN'S SURGERY, LLC
Surgery (Pediatric Surgery)
621 S. NEW BALLAS ROAD, SUITE 6018-B
ST. LOUIS, MO 63141
St. Louis County (314) 251-5940
DR. SAMUEL MARQUEZ M.D.
Surgery
621 S. NEW BALLAS ROAD, SUITE 560A
ST LOUIS, MO 63141
St. Louis County (314) 251-6440
MERCY CLINIC BURN AND PLASTIC SURGERY, LLC
Surgery (Plastic and Reconstructive Surgery)
621 S. NEW BALLAS ROAD, SUITE 7003-B
ST. LOUIS, MO 63141
St. Louis County (314) 251-5570
NICOLE SHUERT NP
Nurse Practitioner (Women's Health)
621 S. NEW BALLAS ROAD, SUITE 4017 TOWER B
ST. LOUIS, MO 63141
St. Louis County (314) 872-9192

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 Theodore Sample's NPI number?

The NPI number for Theodore Sample is 1922191584. It was assigned to this individual provider in the NPPES registry on October 2, 2006.

Where is Theodore Sample located?

Theodore Sample practices at 621 S. New Ballas Road Suite 6009-B, St. Louis, MO 63141. The listed phone number is (314) 251-6598.

What is Theodore Sample's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Theodore Sample enrolled in Medicare?

Yes. Theodore Sample is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Theodore Sample's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Theodore Sample reassigns Medicare benefits to 4 organizations: Mercy Clinic Springfield Communities (Springfield, MO), Mercy Health Physicians-North LLC (Toledo, OH), Valley Children's Medical Group (Modesto, CA) and Enloe Medical Center (Chico, CA). 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 Theodore Sample's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Theodore Sample accept?

Health plans from CareSource list Theodore Sample as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Theodore Sample was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.