JEFFREY SAMELSON (PHD) – Clinical Psychologist, NPI 1801866223
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
450 CLINICAL PSYCHOLOGIST in IN
Provider Addresses for JEFFREY SAMELSON (PHD)
1225, East Coolspring Avenue, Michigan City, LaPorte County, Indiana, 46360, United States
MICHIGAN CITY, IN 463606312
Phone: (219) 873-2964
Fax: (219) 873-2933
Type: Mailing
104 WOODLAND CT STE B
MICHIGAN CITY, IN 463607391
Phone: (219) 628-6463
Fax: (219) 628-6463
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-08-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040813000494 | I | Clinical Psychologist | IN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 90837 | Psychotherapy, 1 hour | 104 | 15 | $0 |
Insurance plans in this area (ZIP 46360)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Psychologist | IN |
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