Independent US Healthcare Provider Directory & Public Medical Database Patient Guides

Dr. Kenneth Jake Sample , MD

Internal Medicine β€’ Gravette, AR

Active NPI 1699358960 Individual Practitioner Male Practitioner Accepts Medicare assignment
Practice location in NPPES

1101 Jackson St Sw
Gravette, AR 727369121

Call 4797875221 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

1101 Jackson St Sw

Gravette, AR 727369121

Telephone 4797875221
Fax 4797875613
Organization at the Same NPPES Address or Phone
Gravette Medical Center Hospital Facility NPI 1295893220

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

Other Listings in Public Data

NPPES lists 2 distinct additional practice-address records in Decatur, AR; Memphis, TN. See the list

Source: CMS NPPES NPI Registry, practice location records; release date unavailable.

CMS Doctors and Clinicians lists 1 group name: Sgoh Acquisition Inc. See the list

Source: CMS Doctors and Clinicians National Downloadable File, release date unavailable.

Listings do not confirm current availability, employment or a shared ownership network.

Medicare Profile & Education

Source: CMS Doctors and Clinicians National Downloadable File

Graduation Year

2021

30-day fills

687 standardized 30-day fills in 2024

CMS converts prescriptions to 30-day supplies so they can be compared. A 90-day prescription counts as about three 30-day fills.

What this does not show: 30-day fills

It is not a count of patients and not a measure of quality.

Part D drug cost

$2,267 in 2024

The total cost of these prescriptions in 2024, paid by Medicare drug plans, patients and other payers together.

What this does not show: Part D drug cost

A higher cost often reflects the type of medicines a specialty uses. It is not your out-of-pocket cost and not a measure of quality.

Source: CMS, Medicare Part D Prescribers – by Provider and Drug, 2024.

Open Payments general payments, program year 2025

All general payments: $73.96 across 3 records.

By nature of payment

  • Food and Beverage: $73.96 across 3 records.

Reporting-company totals

  • VERTEX PHARMACEUTICALS INCORPORATED: $31.35 across 1 record.
  • Inspire Medical Systems, Inc.: $22.03 across 1 record.
  • Viatris Specialty LLC: $20.58 across 1 record.

A reported payment does not necessarily mean the financial relationship is improper and is not a measure of care quality. Clinicians can review and dispute these records.

See the full table

Source: Calculated by T-MedInfo from CMS Open Payments general-payment records for program year 2025 (published June 30, 2026).

Guide: How to read an Open Payments record

Years since graduation

5 years (graduated 2021)

CMS Doctors and Clinicians data list 2021 as the year this clinician finished professional school.

What this does not show: Years since graduation

It is not the number of years in practice, and more years does not mean better care.

Source: CMS Doctors and Clinicians National Downloadable File.

NPI first issued

2021

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Accepts Medicare assignment

CMS data list this clinician as accepting Medicare assignment. This means agreeing to take the Medicare-approved amount as full payment for covered services.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Enrolled in Medicare (PECOS)

Dr. Sample has a Medicare enrollment record in PECOS, the CMS system clinicians use to enroll so they can bill Medicare or order services for people with Medicare.

It does not show whether the clinician accepts assignment, is in your plan's network, or is taking new patients.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What Medicare enrollment (PECOS) means

Can order Medicare-covered services

CMS lists Dr. Sample as eligible to order or refer Medicare Part B clinical laboratory and imaging services, durable medical equipment (DME) and home health services for people with Medicare.

What this does not show: Can order Medicare-covered services

It does not mean the clinician offers these services directly.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What ordering and referring status means

Compared with the same specialty in Gravette and Arkansas

Billing and prescribing volume is not a quality rating.

Medicare Part D prescriptions

Close to the middle for clinicians listed under Internal Medicine in Arkansas (2024, 511 clinicians with data). Median for this group: 433. Middle half: 90 to 6,639.

Too few clinicians listed under Internal Medicine in Gravette have Medicare Part D data for 2024 to compare.

Part D drug cost

A lower Part D drug cost than 70% of clinicians listed under Internal Medicine in Arkansas (2024, 511 clinicians with data). Median for this group: $23,865. Middle half: $1,033 to $430,502.

Too few clinicians listed under Internal Medicine in Gravette have Medicare Part D data for 2024 to compare.

2 active clinicians are listed under Internal Medicine with a practice address in Gravette, AR (768 in Arkansas).

Addresses are self-reported to NPPES and may be out of date.

Sources: CMS Medicare Part D Prescribers (2024), CMS Open Payments (2025), CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Pharma & Medical Device Financial Disclosures

Payments and other transfers of value that drug and medical device companies reported to CMS Open Payments

Open Payments Β· Program Year 2025
Disclosure Year:

Program year 2025 (payments made January 1 – December 31, 2025): fewer than 11 records totaling $73.96.

Manufacturer Payment Nature Product Type Amount ($)
VERTEX PHARMACEUTICALS INCORPORATED
Food and Beverage
In-kind items and services
JOURNAVX General $31.35
Inspire Medical Systems, Inc.
Food and Beverage
In-kind items and services
INSPIRE General $22.03
Viatris Specialty LLC
Food and Beverage
In-kind items and services
YUPELRI General $20.58

Source: CMS Open Payments, program year 2025, released June 30, 2026.

Medicare Part D Prescribing Profile & Medications

Medicare Part D prescriptions filled, including refills, in 2024.

CMS Part D Β· Data Year 2024
Prescription Year:
Brand Name Generic Name Prescriptions Day Supply Total Cost Patients
Atorvastatin Calcium Atorvastatin Calcium 56 4,200 $268.91 28
Amlodipine Besylate Amlodipine Besylate 34 2,820 $159.45 18
Lisinopril Lisinopril 33 2,550 $210.77 21
Gabapentin Gabapentin 32 1,740 $495.79 13
Fluticasone Propionate Fluticasone Propionate 20 1,250 $135.59 14
Furosemide Furosemide 17 857 $30.72 β€”
Hydrochlorothiazide Hydrochlorothiazide 17 1,350 $26.82 β€”
Omeprazole Omeprazole 17 1,290 $282.13 12
Albuterol Sulfate Hfa Albuterol Sulfate 15 514 $315.46 12
Levothyroxine Sodium Levothyroxine Sodium 13 870 $70.55 β€”
Pantoprazole Sodium Pantoprazole Sodium 13 930 $88.56 β€”
Carvedilol Carvedilol 12 1,080 $65.76 β€”
Losartan Potassium Losartan Potassium 11 990 $116.06 β€”

Source: CMS Part D by Provider and Drug, 2024; rows below 11 claims omitted by CMS; volume isn’t quality. Privacy limits

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2024-08-05
Internal Medicine Primary Specialty

NUCC Taxonomy Code: 207R00000X

License # reported to NPPES AR E-18299

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Arkansas State Medical Licensing Board.
Look Up on State Board Site

Medicare (PECOS) Enrollment & Ordering Eligibility

Source: CMS PECOS
Medicare FFS Enrollment Status Medicare Enrollment on File
CMS Provider Specialty

PRACTITIONER - INTERNAL MEDICINE

Medicare Enrollment ID

I20240816001640

Enrollment State Jurisdiction

AR

PECOS Control ID

0244630200

Medicare Order & Referring Eligibility
Clinical Lab & Imaging (Part B) Eligible
Durable Medical Equipment (DME) Eligible
Home Health Agency (HHA) Eligible
Power Mobility Devices (PMD) Eligible

Sources: CMS Provider Enrollment and Order and Referring. Medicare enrollment is a billing status, not an accreditation or quality rating.

Medicare Group Practice Enrollments

Source: CMS Doctors and Clinicians National Downloadable File

Sgoh Acquisition Inc

155 Village Dr, Sparta, MO 657538104

Phone: 4176344203

Sgoh Acquisition Inc

102 Russell Rd, Rogers, AR 727569319

Phone: 4792787189

Sgoh Acquisition Inc

346 N Main St, Decatur, AR 727229732

Phone: 4797523233

Sgoh Acquisition Inc

346 N Main St, Decatur, AR 727229732

Phone: 4797523233

Secondary Practice Locations

920 Madison Ave Ste 447

Memphis, TN 381033438

Phone: 9014485814

346 N Main St

Decatur, AR 727229732

Phone: 4797523233

Clinicians Sharing This Practice Address or Phone

Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.

10 listed
Amelia Jackson , NP-C

Nurse Practitioner

NPI 1093105918

Nurse Practitioner (Certified)

Dr. Nancy Jones , MD

Family Medicine

NPI 1346208527

Doctor of Medicine (M.D.)

Anita Kane , ANP

Nurse Practitioner

NPI 1538117171

Adult Nurse Practitioner

Dr. Vijay Kannam , MD

Family Medicine

NPI 1699039610

Doctor of Medicine (M.D.)

Tamra Lamer , APRN

Nurse Practitioner - Psychiatric/Mental Health

NPI 1235494329

Advanced Practice Registered Nurse

Tracy Lowry , FNP-C

Nurse Practitioner

NPI 1407122179

Family Nurse Practitioner (Certified)

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

9 Historical Events
πŸ“
Updated Practice Location August 05, 2024

Registered at 1101 JACKSON ST SW, GRAVETTE, AR 727369121 (Tel: 4797875221)

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) August 05, 2024

Internal Medicine (license number reported to NPPES: AR E-18299)

πŸ“
Updated Business Mailing Address June 26, 2024

Registered at 1101 JACKSON ST SW, GRAVETTE, AR 727369121

βœ…
NPI Profile Active May 04, 2021

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) May 04, 2021

Registered at 920 MADISON AVE STE 447, MEMPHIS, TN 381033438 (Tel: 9014485814)

πŸ“
Business Mailing Address (Initial Record) May 04, 2021

Registered at 956 COURT AVE # H314, MEMPHIS, TN 381032814

πŸ‘€
Provider Name / Credentials (Initial Record) May 04, 2021

Recorded as KENNETH SAMPLE, MD

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) May 04, 2021

Student in an Organized Health Care Education/Training Program

🟒
Initial NPI Registration & Enumeration May 04, 2021

First registered as active Individual Practitioner in NPPES Database.

No reviews have been published yet. Leave a review.

NPI Administrative Meta

NPI Number: 1699358960
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 04, 2021
Last Update: August 05, 2024
Sole Proprietor: No

Mailing Address

1101 Jackson St Sw

Gravette, AR 727369121

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.