NPIMap

Organization Active NPI

Ayaz Samandani MD SC

  • Family Medicine Physician
  • Beaver Dam, WI
National Provider Identifier
1205248804
Registry record updated May 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AYAZ SAMANDANI MD SC
Practice address
215 Corporate Dr
Suite H
Beaver Dam, WI 53916-3123
Phone
(920) 887-7731
Fax
(920) 887-3201
NPI assigned
May 30, 2014
Last updated
May 30, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2014

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

Authorized official

Name
Ayaz M Samadani, MDNPI 1811947088
Title
MD/Owner
Phone
(920) 887-7731

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

215 Corporate Dr
Suite H
Beaver Dam, WI 53916-3123

Mailing address

215 Corporate Dr
Suite H
Beaver Dam, WI 53916-3123
Phone (920) 887-7731

National Provider Directory

National Provider Directory

Locations

215 Corporate Dr
Ste H
Beaver Dam, WI 53916
Phone (920) 887-7731

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1401408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401408000000",
    "number": "1205248804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 CORPORATE DR",
            "address_2": "SUITE H",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163123",
            "telephone_number": "920-887-7731",
            "fax_number": "920-887-3201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 CORPORATE DR",
            "address_2": "SUITE H",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163123",
            "telephone_number": "920-887-7731",
            "fax_number": "920-887-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AYAZ SAMANDANI MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-30",
        "last_updated": "2014-05-30",
        "status": "A",
        "authorized_official_last_name": "SAMADANI",
        "authorized_official_first_name": "AYAZ",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "920-887-7731",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.