Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Samuel Douglass, DO

Individual provider Diagnostic Radiology Physician · NPI 1063801678

Samuel Douglass, DO is a Diagnostic Radiology in Boise, Idaho. Graduated from Rocky Vista University College of Osteopathic Med in 2015, 11 years ago. Practices with Gem State Radiology LLP, a 42-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in Idaho, Nebraska, Oregon and Washington.

Years since qualifying
11
Trained at
Rocky Vista University College of Osteopathic Med
Licensed in
ID, NE, OR, WA
In the registry since
2015
Specialties on file
4
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

1055 N Curtis Rd
Boise, ID 83706-1309
Phone: (208) 367-2121
Fax: (706) 596-6720
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 300 W Hospital Rd, Fort Gordon, GA 30905-5741 — (706) 787-2175
  • 9040 Fitzsimmons Dr, Joint Base Lewis McChord, WA 98431-1000 — (253) 968-0369
  • 1304 Fawcett Ave Ste 100, Tacoma, WA 98402-1900 — (253) 761-4200

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence OC-0433 (ID)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence OP61322937 (WA)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence DO219310 (OR)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 1539 (NE)

Record details

NPI number1063801678
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedJanuary 20, 2015
Last updated in NPPESApril 18, 2025
Certification dateApril 18, 2025
Mailing address877 W Main St Ste 603, Boise, ID 83702-6070

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolROCKY VISTA UNIVERSITY COLLEGE OF OSTEOPATHIC MED
Graduated 2015 (11 years in practice)
Group practice Gem State Radiology Llp — 42 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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