Samuel Douglass, DO
NPI 1063801678ActiveIndividual· Radiology, Diagnostic Radiology· Boise, ID
Radiology, Diagnostic Radiology (DO) in Boise, Idaho, trained at Rocky Vista University College of Osteopathic Med (class of 2015). Medicare paid $10,467 for services to 431 patients in 2024.
Overview
| NPI | 1063801678 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | DO |
| Sole proprietor | No |
| NPI issued | Jan 20, 2015 |
| Last updated in NPPES | Apr 18, 2025 |
| Certified by provider | Apr 18, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Radiology, Diagnostic Radiology Primary | 2085R0202X | OC-0433 | ID |
| Radiology, Diagnostic Radiology | 2085R0202X | OP61322937 | WA |
| Radiology, Diagnostic Radiology | 2085R0202X | DO219310 | OR |
| Radiology, Diagnostic Radiology | 2085R0202X | 1539 | NE |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Diagnostic Radiology (ID); Practitioner - Diagnostic Radiology (OR); Practitioner - Diagnostic Radiology (UT) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 431 |
|---|---|
| Services billed | 833 across 68 procedure codes |
| Paid by Medicare | $10,467 |
Education and affiliations
| Medical school | Rocky Vista University College of Osteopathic Med |
|---|---|
| Graduation year | 2015 |
| Medicare specialty | Diagnostic Radiology |
Medical groups
- Gem State Radiology LLPBoise, ID · 73 clinicians
- Intermountain Medical Imaging LLCEagle, ID · 38 clinicians
Hospital affiliations
- Saint Alphonsus Medical Center - NampaNampa, ID
- Saint Alphonsus Medical Center OntarioOntario, OR
- Saint Alphonsus Regional Medical CenterBoise, ID
- St Luke's Regional Medical CenterBoise, ID
- St. Alphonsus Medical Center - Baker CityBaker City, OR
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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