SAMUEL GRADY PUTNAM MD NPI 1023066404

NPI Information

  • NPI: 1023066404
  • Provider Name: SAMUEL GRADY PUTNAM, MD
  • Classification: Radiology - 2085R0204X
  • Specialization: Vascular & Interventional Radiology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 55 PHYSICIANS LN
    SOUTHAVEN, MS
    ZIP 38671
  • Phone: (662) 655-2136

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NPI Details

Samuel Grady Putnam, MD is a vascular and interventional radiology radiology in Southaven, MS with 40 years of experience. The provider is a radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. Samuel Grady Putnam, MD NPI is 1023066404. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

55 PHYSICIANS LN
SOUTHAVEN, MS
ZIP 38671-569
Phone: (662) 655-2136
Fax: (662) 996-2214

The NPI 1023066404 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Use of a drug to induce depression of consciousness by physician performing a procedure, each additional 15 minutes (HCPCS:99153)
  • Ultrasound evaluation of blood vessel with review by radiologist, each additional vessel (HCPCS:37253)
  • Ultrasonic guidance for blood vessel access (HCPCS:76937)
  • Ultrasound evaluation of blood vessel with review by radiologist, initial vessel (HCPCS:37252)
  • Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes (HCPCS:99152)
  • Removal of plaque in artery of leg, initial vessel (HCPCS:37229)
  • Review by radiologist of arm or leg artery image (HCPCS:75710)
  • Removal of plaque in arteries of leg (HCPCS:37225)
  • New patient office or other outpatient visit, 45-59 minutes (HCPCS:99204)
  • Removal of plaque in artery of leg, each additional vessel (HCPCS:37233)
  • Balloon dilation of artery of leg, each additional vessel (HCPCS:37232)
  • Review by radiologist of additional artery image (HCPCS:75774)
  • New patient office or other outpatient visit, 30-44 minutes (HCPCS:99203)
  • Leg revascularization (restoring blood flow) (HCPCS:NAN01)

The enumeration date for this NPI number is 5/5/2006 and was last updated on 5/6/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085R0202XRadiologyDiagnostic Radiology25MA09575600NEW JERSEYNo
22085R0202XRadiologyDiagnostic RadiologyMD041221EPENNSYLVANIANo
32085R0202XRadiologyDiagnostic RadiologyC1-0011573DELAWARENo
42085R0204XRadiologyVascular & Interventional RadiologyMD041221EPENNSYLVANIANo
52085R0204XRadiologyVascular & Interventional Radiology25MA09575600NEW JERSEYNo
62085R0204XRadiologyVascular & Interventional Radiology63241TENNESSEENo
72085R0204XRadiologyVascular & Interventional RadiologyMD-23034HAWAIINo
82085R0204XRadiologyVascular & Interventional RadiologyC1-0011573DELAWARENo
92085R0204XRadiologyVascular & Interventional Radiology28916MISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11172545OTHERPENNSYLVANIAAETNA HMO
230026885OTHERPENNSYLVANIAKEYSTONE MERCY
30012723560016MEDICAIDPENNSYLVANIA
40546464000OTHERPENNSYLVANIAAMERIHEALTH/INTERCOUNTY
5300099781OTHERPENNSYLVANIARRM
67929044OTHERPENNSYLVANIAAETNA PPO
70546464000OTHERPENNSYLVANIAIBC - PC/KHPE
8710371OTHERPENNSYLVANIAHIGHMARK BLUE SHIELD
98215722OTHERPENNSYLVANIACIGNA HMO/PPO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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