Dr Shoji Olivo Samson, DO in Peoria, IL

Dr Shoji Olivo Samson, DO is a medicare enrolled "Pediatrics - Neonatal-perinatal Medicine" physician in Peoria, Illinois. His current practice location is 530 Ns Glen Oak Avenue, Peoria, Illinois. You can reach out to his office (for appointments etc.) via phone at (309) 624-2896.

Dr Shoji Olivo Samson is licensed to practice in Illinois (license number 036152483) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1831504067.

Contact Information

	Dr Shoji Olivo Samson, DO
	530 Ns Glen Oak Avenue, Peoria, IL 61637-0001
	(309) 624-2896
	(309) 655-2974

Map and Direction

Physician's Profile

Full Name	Dr Shoji Olivo Samson
Gender	Male
Speciality	Pediatrics - Neonatal-perinatal Medicine
Location	530 Ns Glen Oak Avenue, Peoria, Illinois
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1831504067
Provider Enumeration Date: 06/26/2014
Last Update Date: 01/04/2022

Medicare PECOS Information:

PECOS PAC ID: 6103237961
Enrollment ID: I20201130001274

Medical Identifiers

Medical identifiers for Dr Shoji Olivo Samson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1831504067	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208000000X	Pediatrics	S0375 (Texas)	Secondary
208000000X	Pediatrics	DO-05910 (Iowa)	Secondary
208000000X	Pediatrics	288816 (New York)	Secondary
208000000X	Pediatrics	036152483 (Illinois)	Secondary
2080N0001X	Pediatrics - Neonatal-perinatal Medicine	DO-05910 (Iowa)	Secondary
2080N0001X	Pediatrics - Neonatal-perinatal Medicine	288816 (New York)	Secondary
2080N0001X	Pediatrics - Neonatal-perinatal Medicine	S0375 (Texas)	Secondary
2080N0001X	Pediatrics - Neonatal-perinatal Medicine	036152483 (Illinois)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Shoji Olivo Samson allows following entities to bill medicare on his behalf.

Entity Name	The Board Of Trustees Of The University Of Illinois
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1386863819 PECOS PAC ID: 3072422716 Enrollment ID: O20031112000158

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Shoji Olivo Samson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Shoji Olivo Samson, DO 530 Ns Glen Oak Avenue, Peoria, IL 61637-0001 Ph: (096) 242-8963	Dr Shoji Olivo Samson, DO 530 Ns Glen Oak Avenue, Peoria, IL 61637-0001 Ph: (309) 624-2896

Reviews and Comments

Pediatrics Doctors in Peoria, IL

Thomas James Mcmorrow, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2553 Fax: 309-655-2602
Jessica Ford-davis, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2274
Kelsey Elizabeth Grimes, DO Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000
Jessica N Mistretta, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000
Mrs. Valeria Claudia Benavides Lopez, M.D., M.P.H. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-624-3313
Khalid Al Katranji, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-7171
Dr. Gretchen L Kopec, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-624-0615

Dr Shoji Olivo Samson, DO - Medicare Pediatrics in Peoria, IL