NPIMap

Organization Active NPI

Ayaz M. Samadani, MD, SC

  • Clinic/Center
  • Beaver Dam, WI
National Provider Identifier
1396985636
Registry record updated Jul 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
AYAZ M. SAMADANI, MD, SC
Practice address
215 Corporate Dr
Suite H
Beaver Dam, WI 53916-3123
Phone
(920) 887-7731
NPI assigned
Feb 26, 2009
Last updated
Jul 14, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 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
Owner
Phone
(920) 887-7731

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
Clinical Medical Laboratory 291U00000X NU
Durable Medical Equipment & Medical Supplies 332B00000X NU

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

Other identifiers 1

IdentifierTypeStateIssuer
P61OtherWIDEAN HEALTH INSURANCE

National Provider Directory

National Provider Directory

Locations

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

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1235606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405296000000",
    "number": "1396985636",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AYAZ M. SAMADANI, MD, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-26",
        "last_updated": "2014-07-14",
        "status": "A",
        "authorized_official_last_name": "SAMADANI",
        "authorized_official_first_name": "AYAZ",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-887-7731",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH INSURANCE",
            "identifier": "P61",
            "state": "WI"
        }
    ],
    "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 Jul 14, 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.