Individual provider Active NPI

Samuel Kotran, DO

  • Emergency Medicine Physician
  • Palm Springs, CA
National Provider Identifier
1144849407
Registry record updated Dec 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
20A19742 Issued in CA
Practice address
1150 N Indian Canyon Dr
Palm Springs, CA 92262-4872
Phone
(760) 323-6511
NPI assigned
Apr 15, 2020
Last updated
Dec 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 20A19742 CA Primary

Addresses

Primary practice location

1150 N Indian Canyon Dr
Palm Springs, CA 92262-4872

Mailing address

400 N Sunrise Way Apt 256
Palm Springs, CA 92262-0311
Phone (330) 819-1175

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230622002306 CA Practitioner - Emergency Medicine 1850759887 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America - CaliforniaGroup PAC ID 6103739131, shared by 2 NPIs, 1,278 clinicians

Practice addresses (Care Compare)

1150 M Indian Canyon Dr
Palm Springs, CA 92262-4872
Phone (760) 323-6511

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
19742CAMDSocial Worker
20A19742CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Nov 20, 2023 Accepting new patients
Cep America-California Emergency Medicine CurrentSince Jul 1, 2023 Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Cep America - California Emergency Medicine CurrentSince Jul 1, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 20, 2023 Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients
Cep America - California Emergency Medicine CurrentSince Jul 1, 2023 Accepting new patients

Locations

18300 US Highway 18
Apple Valley, CA 92307
Phone (760) 424-2311

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

6601 White Feather Rd
Joshua Tree, CA 92252
Phone (760) 366-1500

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

1150 N Indian Canyon Dr
Palm Springs, CA 92262
Phone (760) 323-6251

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

350 Terracina Blvd
Redlands, CA 92373
Phone (909) 335-5500

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

Organizations & group practices 8

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1144849407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N SUNRISE WAY APT 256",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922620311",
            "telephone_number": "330-819-1175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N INDIAN CANYON DR",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922624872",
            "telephone_number": "760-323-6511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTRAN",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-15",
        "last_updated": "2023-12-22",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "20A19742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Palm Springs, CA

Sources for this page

Verify at the official NPI Registry.