Momona Woldemicael Samuel

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95018215 Issued in CA

Practice address

808 W 58TH St
Los Angeles, CA 90037-3632

Phone

(323) 541-1600

NPI assigned

Aug 10, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. John's Community HealthGroup PAC ID 2961482690, 151 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: momona.samuel@sjch.eclinicaldirectplus.com

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.

• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1073653630
  Medicare reassignment Care Compare group NPD
• St. Johns Community Health

  • Community Health Clinic/Center
  • Los Angeles, CA
  • NPI 1073363768
  NPD
• St. Johns Community Health

  • Community Health Clinic/Center
  • Los Angeles, CA
  • NPI 1629491089
  NPD
• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
  • NPI 1780376947
  NPD (past)

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

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1124793419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4619 S ORCAS ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981182432",
            "telephone_number": "323-717-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 W 58TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373632",
            "telephone_number": "323-541-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "MOMONA",
        "middle_name": "WOLDEMICAEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61155406",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95018215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Diane Samuel-Cato, L.M.F.T.
• Dee Ann Maude Samuel, LVN
• Diana Samuel, BA
• Dorotha Lee Samuel
• Mark Shawn Samuel
• Scott Samuel
• Gabrielle B Samuels
• Howard Samuels
• Jasmine Joy Samuels
• Jennifer Lee Samuels, RN, MSN, CPNP

• Family Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.