NPIMap

Individual provider Active NPI

Georgina A Samuel, PA-C

  • Physician Assistant
  • Fairfield, CA
National Provider Identifier
1427296292
Registry record updated Jul 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA20158 Issued in CA
Practice address
470 Chadbourne Rd Ste a
Fairfield, CA 94534-9620
Phone
(707) 419-8989
Fax
(707) 254-1779
NPI assigned
Feb 1, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA20158 CA Primary

Addresses

Primary practice location

470 Chadbourne Rd Ste a
Fairfield, CA 94534-9620

Mailing address

1141 Pear Tree LN
Napa, CA 94558-6484
Phone (707) 254-1770

Other names 1

  • Georgina Graves Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20090414000392 CA Practitioner - Physician Assistant 0941357743 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ole HealthGroup PAC ID 7315934767, 9 clinicians

Practice addresses (Care Compare)

1101 B Gale Wilson Blvd
Suite 101C
Fairfield, CA 94533-3771
Phone (707) 419-8990

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
20158CAMDOccupational Therapist
PA20158CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ole Health CurrentSince Jul 11, 2011 Accepting new patients
Ole Health Past Accepting new patients
Ole Health Past Accepting new patients

Locations

470 Chadbourne Rd
Ste A
Fairfield, CA 94534
Phone (707) 419-8989

1141 Pear Tree Ln
Ste 100
Napa, CA 94558
Phone (707) 254-1778

Interoperability endpoints

  • Direct secure messaging: gsamuel676053@direct.ochin.org

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1233446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1427296292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1141 PEAR TREE LN",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945586484",
            "telephone_number": "707-254-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 CHADBOURNE RD STE A",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945349620",
            "telephone_number": "707-419-8989",
            "fax_number": "707-254-1779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "GEORGINA",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-01",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA20158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GEORGINA",
            "last_name": "GRAVES",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fairfield, CA

Sources for this page

Verify at the official NPI Registry.