NPIMap

Organization Active NPI

Sam Naficy, MD, PS, Inc

  • Ambulatory Surgical Clinic/Center
  • Bellevue, WA
National Provider Identifier
1265614523
Registry record updated Feb 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
HC00140296 Issued in WA
Legal business name
SAM NAFICY, MD, PS, INC
Practice address
1110 112TH Ave NE
Suite 150
Bellevue, WA 98004-4509
Phone
(425) 450-0880
Fax
(425) 450-0883
NPI assigned
Nov 28, 2007
Last updated
Feb 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2008

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

Authorized official

Name
Dr. Sam Naficy, MDNPI 1801816947
Title
Director
Phone
(425) 450-0880

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
Ambulatory Surgical Clinic/Center 261QA1903X HC00140296 WA Primary

Addresses

Primary practice location

1110 112TH Ave NE
Suite 150
Bellevue, WA 98004-4509

Mailing address

1110 112TH Ave NE
Suite 150
Bellevue, WA 98004-4509
Phone (425) 450-0880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040406000658 WA Part B Supplier - Clinic/Group Practice 5991798902 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bellevue, WA; Kirkland, WA
O20040407000088 WA Part B Supplier - Clinic/Group Practice 3072506849 Receives reassigned benefits from 2 practitioners
Practice locations: Bellevue, WA
O20051202000099 WA Part B Supplier - Ambulatory Surgical Center 3072506849 Practice locations: Bellevue, WA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Sam Naficy MD PS IncCCN 50C0001246
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

1600 Continental Pl
Ste 101
Mount Vernon, WA 98273
Phone (360) 336-3026

622 S 36th Ave
Yakima, WA 98902
Phone (509) 824-6287

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203379200000",
    "number": "1265614523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 112TH AVE NE",
            "address_2": "SUITE 150",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044509",
            "telephone_number": "425-450-0880",
            "fax_number": "425-450-0883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 112TH AVE NE",
            "address_2": "SUITE 150",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044509",
            "telephone_number": "425-450-0880",
            "fax_number": "425-450-0883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM NAFICY, MD, PS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2008-02-19",
        "status": "A",
        "authorized_official_last_name": "NAFICY",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "425-450-0880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WA",
            "license": "HC00140296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.