Active NPI
Imelda CHI Sam, NP-C
- Primary Care Nurse Practitioner
- Las Vegas, NV
National Provider Identifier
1053819755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Nurse Practitioner
- License
- APRN002763
- Practice address
- 3968 N Rancho Dr
Las Vegas, NV 89130-3412 - Phone
- (702) 791-9020
- Fax
- (702) 791-9261
- NPI assigned
- Jan 28, 2018
- Last updated
- Jul 5, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | APRN00002763 | NV | |
| Primary Care Nurse Practitioner | 363LP2300X | APRN002763 | NV | Primary |
Addresses
Primary practice location
3968 N Rancho Dr
Las Vegas, NV 89130-3412
Mailing address
6900 N Pecos Rd
North Las Vegas, NV 89086-4400
Phone (702) 791-9000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN00002763 | NV | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| R Muthaiah MD PC | Current | Accepting new patients |
Locations
5061 N Rainbow Blvd
Ste 180
Las Vegas, NV 89130
Phone (702) 220-8001
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688515200000",
"number": "1053819755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6900 N PECOS RD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890864400",
"telephone_number": "702-791-9000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3968 N RANCHO DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891303412",
"telephone_number": "702-791-9020",
"fax_number": "702-791-9261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAM",
"first_name": "IMELDA",
"middle_name": "CHI",
"credential": "NP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-28",
"last_updated": "2023-07-05",
"certification_date": "2023-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "NV",
"license": "APRN00002763",
"primary": false
},
{
"code": "363LP2300X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Primary Care",
"state": "NV",
"license": "APRN002763",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.