NPIMap

Individual provider Active NPI

Samantha Lynn Besoyan, PA-C

  • Physician Assistant
  • Kingsburg, CA
National Provider Identifier
1154850410
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4177 Avenue 368
Kingsburg, CA 93631-9626
Phone
(559) 897-6018
Fax
(559) 741-4398
NPI assigned
Jun 8, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

4177 Avenue 368
Kingsburg, CA 93631-9626

Mailing address

4177 Avenue 368
Kingsburg, CA 93631-9626
Phone (559) 897-6018

Other names 1

  • Samantha Lynn Clark Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180118002733 CA Practitioner - Physician Assistant 6901165935 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
54784CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Healthcare Network CurrentSince Dec 17, 2017 Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network CurrentSince Dec 17, 2017 Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network PastSince Mar 1, 2020 Accepting new patients
Family Healthcare Network Past Accepting new patients
Family Healthcare Network PastSince Mar 1, 2020 Accepting new patients

Locations

305 E Center Ave
Visalia, CA 93291
Phone (559) 737-4792

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CCECCA

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1154850410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4177 AVENUE 368",
            "city": "KINGSBURG",
            "state": "CA",
            "postal_code": "936319626",
            "telephone_number": "559-897-6018",
            "fax_number": "559-741-4398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4177 AVENUE 368",
            "city": "KINGSBURG",
            "state": "CA",
            "postal_code": "936319626",
            "telephone_number": "559-897-6018",
            "fax_number": "559-741-4398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BESOYAN",
        "first_name": "SAMANTHA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-08",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "CLARK",
            "middle_name": "LYNN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kingsburg, CA

Sources for this page

Verify at the official NPI Registry.