Samuel Hailemariam Fantaye, MD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

A169452 Issued in CA

Practice address

20642 John Dr
Castro Valley, CA 94546-5103

Phone

(510) 857-2559

NPI assigned

May 24, 2017

Last updated

Oct 8, 2024By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, GA2 enrollments

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 2

Specialty

Internal MedicineAlso: Endocrinology

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Morehouse Medicine Inc.Group PAC ID 3779082631, 30 clinicians

Morehouse Healthcare, Inc.Group PAC ID 6002701273, 155 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grady Memorial Hospital Hospital, Atlanta, GA, CCN 110079

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sfantaye2945999@carolinashealthcaresystem.direct-ci.com
• Direct secure messaging: sfantaye35279@direct.utmsa.com

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.

• Morehouse Healthcare, Inc.

  • Cardiovascular Disease Physician
  • Atlanta, GA
  • NPI 1801832324

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Morehouse Medicine Inc.

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1700673571
  Medicare reassignment Care Compare group NPD
• University of Texas Health Science Center at San Antonio

  dba UT Health Physicians

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1720051717
  Medicare reassignment NPD
• The University of Texas Health Science Center at San Antonio

  dba UT Health San Antonio Multispecialty & Research Hospital

  • General Acute Care Hospital
  • San Antonio, TX
  • NPI 1326829904
  NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Grady Memorial Hospital Corporation

  dba Grady Health Systems

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1992799050
  Care Compare affiliation

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

{
    "created_epoch": "1495584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1336677186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20642 JOHN DR",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20642 JOHN DR",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465103",
            "telephone_number": "510-857-2559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTAYE",
        "first_name": "SAMUEL",
        "middle_name": "HAILEMARIAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-24",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A169452",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CA",
            "license": "A169452",
            "primary": true
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "CA",
            "license": "A169452",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane Henderson Eversole, PT, MA
• Exceed GS LLC (Exceed Medical Group)
• Eye Specialties Medical Group Inc.
• Eyebright Optometry
• Rebecca Lee Fallen
• Joell Farrar
• Joseph P Farrell, PHYSICAL THERAPIST
• Farnoosh Farrokhi
• Teofik Fehimovic
• Li Feng Feng

• Endocrinology, Diabetes & Metabolism Physician in Castro Valley, CA
• Providers in Castro Valley, CA by specialty
• Endocrinology, Diabetes & Metabolism Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; 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.
• 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.