Individual provider Active NPI

Samuel Jacob Stierman, MD

  • Internal Medicine Physician
  • Glendale, AZ
National Provider Identifier
1164423273
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
19199 Issued in AZ
Practice address
5651 W Talavi Blvd Ste 170
Glendale, AZ 85306-1893
Phone
(602) 843-1313
NPI assigned
Aug 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 19199 AZ Primary

Addresses

Primary practice location

5651 W Talavi Blvd Ste 170
Glendale, AZ 85306-1893

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380

Other practice location 1

5601 W Eugie Ave
Suite 210
Glendale, AZ 85304-1255
Phone (602) 843-1313

Other identifiers 7

IdentifierTypeStateIssuer
1031014OtherAETNA
AZ824340OtherBCBS
1Z7305OtherHEALTH NET
5197885006OtherCIGNA 200
110173205OtherRR MEDICARE
5197885007OtherCIGNA 210
860923905OtherHUMANA PPO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20101206000556 AZ Practitioner - Internal Medicine 2769679539 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19199AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Consultants in Internal Medicine, P.C. CurrentSince Aug 1, 1998 Accepting new patients
Greater Phoenix Collaborative Care PC CurrentSince Jan 1, 2025 Accepting new patients
Greater Phoenix Collaborative Care PC CurrentSince Jan 1, 2025 Accepting new patients

Locations

5601 W Eugie Ave
Ste 210
Glendale, AZ 85304
Phone (602) 633-3833

17218 N 72nd Dr
Ste 100
Glendale, AZ 85308
Phone (623) 334-8670

5651 W Talavi Blvd
Ste 170
Glendale, AZ 85306
Phone (602) 843-1313

5701 W Talavi Blvd
Ste 110
Glendale, AZ 85306
Phone (602) 843-1313

5830 N 19th Ave
Phoenix, AZ 85015
Phone (602) 249-0115

1460 W Valencia Rd
Tucson, AZ 85746
Phone (520) 573-0966

Organizations & group practices 3

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1164423273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5651 W TALAVI BLVD STE 170",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853061893",
            "telephone_number": "602-843-1313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5601 W Eugie Ave",
            "address_2": "Suite 210",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853041255",
            "country_code": "US",
            "telephone_number": "602-843-1313",
            "fax_number": "602-843-0191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STIERMAN",
        "first_name": "SAMUEL",
        "middle_name": "JACOB",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "19199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1031014",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ824340",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "1Z7305",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA 200",
            "identifier": "5197885006",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110173205",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA 210",
            "identifier": "5197885007",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA PPO",
            "identifier": "860923905",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.