Samuel N Addison, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

11509 Issued in NC

Practice address

8305 Falls of Neuse Rd Ste 105
Raleigh, NC 27615-3546

Phone

(919) 841-1720

Fax

(919) 841-1725

NPI assigned

Jun 23, 2011

Last updated

Jun 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 13, 2019 through Jul 13, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• K. Kevin Neshat, DDS, MD, PA

  dba Nu-Image Surgical Center

  • Oral and Maxillofacial Surgery Clinic/Center
  • Raleigh, NC
  • NPI 1770637779
  NPD (past)

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

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561507200000",
    "number": "1285920769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8305 FALLS OF NEUSE RD STE 105",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276153546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8305 FALLS OF NEUSE RD STE 105",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276153546",
            "telephone_number": "919-841-1720",
            "fax_number": "919-841-1725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDISON",
        "first_name": "SAMUEL",
        "middle_name": "N",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-23",
        "last_updated": "2019-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "11509",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MA",
            "license": "DL-11243",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Addertion, LCSWA
• Addiction Medicine Partners
• Addison Home Care Services LLC
• Jackie Addison
• Nancy Addison, LCSW
• Carrye Lee Addonizio, LCSW
• Alfred Addy, RPH
• Alice Adebolanle Adebari
• Michael Olusegun Adejimi
• Richard D Adelman, MD

• Oral and Maxillofacial Surgery (Dentist) in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.