NPIMap

Organization Active NPI

Cardiology Assoc of Port Huron

  • Cardiovascular Disease Physician
  • Port Huron, MI
National Provider Identifier
1033198593
Registry record updated Mar 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
4301048340 Issued in MI
Legal business name
CARDIOLOGY ASSOC OF PORT HURON
Practice address
1222 10TH Ave
Port Huron, MI 48060-3406
Phone
(810) 985-9681
Fax
(810) 985-3590
NPI assigned
Jan 12, 2006
Last updated
Mar 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2022

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

Authorized official

Name
Dr. Bashar Samman, MDNPI 1558322743
Title
President
Phone
(810) 985-9681

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 4301048340 MI Primary

Addresses

Primary practice location

1222 10TH Ave
Port Huron, MI 48060-3406

Mailing address

44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-5000

Other identifiers 2

IdentifierTypeStateIssuer
770G460150OtherMIBLUE CROSS BLUE SHIELD
3066919MedicaidMI

Other names 1

  • port huron heart center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040916000650 MI Part B Supplier - Clinic/Group Practice 1658348776 Receives reassigned benefits from 15 practitioners
Practice locations: Fort Gratiot, MI; Deckerville, MI; Port Huron, MI

National Provider Directory

National Provider Directory

Locations

4190 24th Ave
Ste 203
Fort Gratiot, MI 48059
Phone (810) 989-7490

4190 24th Ave
Ste 204
Fort Gratiot, MI 48059
Phone (810) 216-1000

1222 10th Ave
Port Huron, MI 48060
Phone (810) 985-9681

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647475200000",
    "number": "1033198593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44201 DEQUINDRE RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480851117",
            "telephone_number": "248-964-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 10TH AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603406",
            "telephone_number": "810-985-9681",
            "fax_number": "810-985-3590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIOLOGY ASSOC OF PORT HURON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-12",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A",
        "authorized_official_last_name": "SAMMAN",
        "authorized_official_first_name": "BASHAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-985-9681",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301048340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "770G460150",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3066919",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "port huron heart center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "port huron heart center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.