NPIMap

Individual provider Active NPI

Samir K Yassa, MD

  • Nephrology Physician
  • Merritt Island, FL
National Provider Identifier
1427157494
Registry record updated Nov 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME90329 Issued in FL
Practice address
245 S Curtenay Parkway
BLDG B
Merritt Island, FL 32952
Phone
(321) 453-5326
Fax
(321) 452-8507
NPI assigned
Sep 22, 2006
Last updated
Nov 1, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME90329 FL Primary

Addresses

Primary practice location

245 S Curtenay Parkway
BLDG B
Merritt Island, FL 32952

Mailing address

245 S Courtenay Parkway
BLDG B
Merritt Island, FL 32952
Phone (321) 453-5326

Other identifiers 3

IdentifierTypeStateIssuer
270784500MedicaidFL
7709220OtherAETNA
P00145735OtherRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041011000190 FL Practitioner - NephrologyPractitioner - Internal Medicine 0648239004 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brevard Nephrology Group PAGroup PAC ID 3779554985, 5 clinicians

Practice addresses (Care Compare)

245 S Courtenay Pkwy
Merritt Island, FL 32952-4831
Phone (321) 453-5326

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME90329FLMDNephrology Physician
1925NYMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Brevard Nephrology Group PA Nephrology CurrentSince Jul 19, 2004 Accepting new patients
Dr. Shoukri M. Wisa Medical Care PLLC PastSince Sep 15, 2008 Accepting new patients

Locations

245 S Courtenay Pkwy
Ste B
Merritt Island, FL 32952
Phone (321) 453-5326

245 S Courtenay Pkwy
Merritt Island, FL 32952
Phone (321) 453-5326

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: syassa22982@epicdirect.hf.org
  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72643

Organizations & group practices 2

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1427157494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 S COURTENAY PARKWAY",
            "address_2": "BLDG B",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "32952",
            "telephone_number": "321-453-5326",
            "fax_number": "321-452-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 S CURTENAY PARKWAY",
            "address_2": "BLDG B",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "32952",
            "telephone_number": "321-453-5326",
            "fax_number": "321-452-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YASSA",
        "first_name": "SAMIR",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME90329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270784500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7709220",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00145735",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

Verify at the official NPI Registry.