Individual provider Active NPI

Saymu Geneyan- Sackor

  • Gerontology Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1417841305
Registry record updated Jun 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
SP032689 Issued in PA
Practice address
4055 Valley View LN Ste 700
Dallas, TX 75244-5045
Phone
(214) 207-3831
NPI assigned
Jun 5, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X SP032689 PA Primary

Addresses

Primary practice location

4055 Valley View LN Ste 700
Dallas, TX 75244-5045

Mailing address

4055 Valley View LN Ste 700
Dallas, TX 75244-5045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260116001762 NJ Practitioner - Nurse Practitioner 0648757948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1481 McDonald Ave
Brooklyn, NY 11230-4667

6929 Dicks Ave
Philadelphia, PA 19142-2119

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP032689PAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Renew Wound Care of New Jersey LLC CurrentSince Dec 1, 2025 Accepting new patients

Locations

1481 McDonald Ave
Brooklyn, NY 11230
Phone (347) 479-1110

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1749081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749081600000",
    "number": "1417841305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 VALLEY VIEW LN STE 700",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752445045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 VALLEY VIEW LN STE 700",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752445045",
            "telephone_number": "214-207-3831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENEYAN- SACKOR",
        "first_name": "SAYMU",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-05",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SP032689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.