Sam Tarik Mendoune I, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

F311288 Issued in NY

Practice address

101 Nicolls Rd
Stony Brook, NY 11794-0001

Phone

(631) 335-1657

NPI assigned

Jul 28, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stony Brook Internists University Faculty Practice CorporationGroup PAC ID 9133019821, 427 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stony Brook Internists, University Faculty Practice Corporation

  • Internal Medicine Physician
  • Stony Brook, NY
  • NPI 1821035601
  Medicare reassignment Care Compare group NPD
• Stony Brook Internists, University Faculty Practice Corporation

  • Cardiac Rehabilitation Registered Nurse
  • Stony Brook, NY
  • NPI 1295778371
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1003597469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 MARC DR",
            "city": "RIDGE",
            "state": "NY",
            "postal_code": "119612139",
            "telephone_number": "631-335-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-335-1657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOUNE",
        "first_name": "SAM",
        "middle_name": "TARIK",
        "name_prefix": "Mr.",
        "name_suffix": "I",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-28",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F311288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tehsim Aziz Memon, MBBS, MD
• Hayley Alexandra Mena, LMSW
• Eyal Menashe
• Mendelsohn Medical, PLLC
• Corinna Luise Mendis, R.PA.C.
• Michelle Menezes
• Richard S Menjivar, PMHNP
• Julie Mercado, DMD
• Amanda Mercurio, PHARM.D.
• Georges Merhy, M.D

• Adult Health Nurse Practitioner in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.