DR. SHOJI OLIVO SAMSON DO
NPI 1831504067
Pediatrics - Neonatal-Perinatal Medicine in Peoria, IL
NPI Status: Active since June 26, 2014
Contact Information
530 NS GLEN OAK AVENUE
PEORIA, IL
ZIP 61637
Phone: (309) 624-2896
Fax: (309) 655-2974
- Individual
- Male
- Pediatrics
- Neonatal-Perinatal Medicine
- Accepts Insurance
- PECOS Enrolled
About SHOJI SAMSON
This page provides the complete NPI Profile along with additional information for Shoji Samson, a pediatrician established in Peoria, Illinois with a medical specialization in Pediatrics, focusing in neonatal-perinatal medicine . The healthcare provider is registered in the NPI registry with number 1831504067 assigned on June 2014. The practitioner's primary taxonomy code is 2080N0001X with license number 036152483 (IL). The provider is registered as an individual and his NPI record was last updated 4 years ago.
- NPI
- 1831504067
- Provider Name
- DR. SHOJI OLIVO SAMSON DO
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 530 NS GLEN OAK AVENUE PEORIA, IL 61637
- Location Phone
- (309) 624-2896
- Location Fax
- (309) 655-2974
- Mailing Address
- 530 NS GLEN OAK AVENUE PEORIA, IL 61637
- Mailing Phone
- (096) 242-8963
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 06-26-2014
- Last Update Date
- 01-04-2022
- Code Navigator
A pediatrician like Shoji Samson is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.
Location Map
Secondary Locations
- 507 E Armstrong Ave
Peoria, IL 61603
(309) 681-9690 - 2200 E Washington St
Bloomington, IL 61701
(309) 662-3311
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pediatrics Neonatal-Perinatal Medicine
- Taxonomy Code
- 2080N0001X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 036152483
- License State
- IL
- Taxonomy Description
- A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | S0375 (TX) |
| 2 | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | DO-05910 (IA) |
| 3 | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | 288816 (NY) |
| 4 | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | 036152483 (IL) |
| 5 | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | DO-05910 (IA) |
| 6 | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | 288816 (NY) |
| 7 | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | S0375 (TX) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Choice Preferred Bronze PPO? 201 - PPO
- Blue Choice Preferred Bronze PPO? 701 - PPO
- Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays - PPO
- Blue Choice Preferred Gold PPO? 204 - PPO
- Blue Choice Preferred Gold PPO? 901 - PPO
- Blue Choice Preferred Gold PPO? Standard - Rx Copays - PPO
- Blue Choice Preferred Security PPO? 200 - PPO
- Blue Choice Preferred Silver PPO? 203 - PPO
- Blue Choice Preferred Silver PPO? 801 - PPO
- Blue Choice Preferred Silver PPO? Standard - Select Rx Copays - PPO
- Blue Precision Bronze HMO? 205 - HMO
- Blue Precision Bronze HMO? 701 - HMO
- Blue Precision Bronze HMO? Standard - Select Rx Copays - HMO
- Blue Precision Gold HMO? 207 - HMO
- Blue Precision Gold HMO? 703 - HMO
- Blue Precision Gold HMO? Standard - Rx Copays - HMO
- Blue Precision Silver HMO? 206 - HMO
- Blue Precision Silver HMO? 704 - HMO
- Blue Precision Silver HMO? Standard - Select Rx Copays - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Shoji Samson is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 8 | 3 | 1 | 5 | 0 | 4 | 0 | 6 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 8 | 6 | 1 | 10 | 0 | 8 | 0 | 12 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 8 + 6 + 1 + 1 + 0 + 0 + 8 + 0 + 1 + 2 + 24 = 53 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 53 = 7 | 7 | ||||||||
The NPI number 1831504067 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1831504067, enumerated in the NPI registry as an "individual" on June 26, 2014
The provider is located at 530 Ns Glen Oak Avenue Peoria, Il 61637 and the phone number is (309) 624-2896
The provider's speciality is Pediatrics with taxonomy code 2080N0001X with a focus in Neonatal-Perinatal Medicine
The provider might be accepting Accepts: Blue Cross and Blue Shield of Illinois. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
This NPI record was last updated on June 26, 2014. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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