Om Sam, MD - Medicare Family Medicine in Sullivan, MO

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Om Sam, MD is a medicare enrolled "Family Medicine" physician in Sullivan, Missouri. His current practice location is 965 Mattox Dr, Sullivan, Missouri. You can reach out to his office (for appointments etc.) via phone at (573) 860-6000.

Om Sam is licensed to practice in Missouri (license number 2021026443) 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 1457845588.

Contact Information

Om Sam, MD
965 Mattox Dr,
Sullivan, MO 63080-2365
(573) 860-6000
Not Available

Map and Direction




Physician's Profile

Full NameOm Sam
GenderMale
SpecialityFamily Medicine
Location965 Mattox Dr, Sullivan, Missouri
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1457845588
  • Provider Enumeration Date: 06/21/2018
  • Last Update Date: 07/29/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 6002211885
  • Enrollment ID: I20210817001146

Medical Identifiers

Medical identifiers for Om Sam such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1457845588NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine 2021026443 (Missouri)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. Om Sam allows following entities to bill medicare on his behalf.
Entity NameMissouri Baptist Hospital Of Sullivan
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1396827408
PECOS PAC ID: 2668380148
Enrollment ID: O20050519000401
Entity NameMissouri Baptist Hospital Of Sullivan
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1295743169
PECOS PAC ID: 2668380148
Enrollment ID: O20060410000616

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. Om Sam 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 AddressPractice Location Address
Om Sam, MD
965 Mattox Dr,
Sullivan, MO 63080-2365

Ph: (573) 860-6000		Om Sam, MD
965 Mattox Dr,
Sullivan, MO 63080-2365

Ph: (573) 860-6000

Reviews and Comments


Family Medicine Doctors in Sullivan, MO

Dr. Patricia Hinkle, M.D.
Family Medicine
Medicare: Not Enrolled in Medicare
Practice Location: 101 Progress Pkwy, Sullivan, MO 63080
Phone: 888-403-1071    
Matthew J Tiefenbrunn, M.D.
Family Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 1326 S Service Rd W Ste 10, Sullivan, MO 63080
Phone: 573-468-4455    
Armela Agasino, MD
Family Medicine
Medicare: Not Enrolled in Medicare
Practice Location: 751 Sappington Bridge Rd, Sullivan, MO 63080
Phone: 573-468-1997    Fax: 573-468-1998
Dr. Rebekah Allen, DO
Family Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 751 Sappington Bridge Rd, Sullivan, MO 63080
Phone: 573-468-4186    Fax: 573-860-6179

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.