SHANE TIMOTHY SAMPSON (MD) – Family Medicine Physician, NPI 1023080116
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,431 FAMILY PRACTICE in OH
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Provider Addresses for SHANE TIMOTHY SAMPSON (MD)
Miamisburg Centerville Road, Centerville, Montgomery County, Ohio, 45459-4011, United States
CENTERVILLE, OH 454593858
Phone: (937) 434-7353
Fax: (937) 438-6569
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 19 Open Payments records for all available years, with a total value of $385.
Total Amount is formed as General ($385) + Research ($0) + Ownership ($0) = $385.
Last reported payment date: 2024-11-08 • Largest payer in this snapshot: ABBVIE INC. ($105).
Total Amount
$385
General + Research + Ownership
Payments
19
Total payment records
General Amount
$385
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-08
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $105 |
| Exact Sciences Corporation | $67 |
| Novo Nordisk Inc | $54 |
| GlaxoSmithKline, LLC. | $39 |
| Vifor Pharma, Inc. | $31 |
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: 2022-08-03
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 |
|---|---|---|---|---|
| I20220803001589 | I | Family Practice | FL | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 542 | 328 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 224 | 160 | $0 |
| J1885 | Injection, ketorolac tromethamine, per 15 mg | 144 | 31 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 113 | 113 | $0 |
| G0444 | Annual depression screening, 5 to 15 minutes | 106 | 106 | $0 |
Insurance plans in this area (ZIP 45459)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | OH | 81002 | Urinalysis, manual test | 68 | 45 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | FL | |
| - | FL | |
| - | TX | |
| Nurse Practitioner | FL | |
| - | FL | |
| Family Practice | FL | |
| Nurse Practitioner | FL | |
| Nurse Practitioner | FL | |
| General Practice | FL | |
| - | FL |
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