NPIMap

Individual provider Active NPI

Samer Ajam, MD

  • Clinical Cardiac Electrophysiology Physician
  • Hobart, IN
National Provider Identifier
1467680942
Registry record updated Jun 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
01069863A Issued in IN
Practice address
1500 S Lake Park Ave
Ste 110
Hobart, IN 46342-6638
Phone
(219) 947-6017
Fax
(219) 947-6018
NPI assigned
Jun 23, 2009
Last updated
Jun 7, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 7, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01069863A IN
Cardiovascular Disease Physician 207RC0000X 01069863A IN
Clinical Cardiac Electrophysiology Physician 207RC0001X 01069863A IN Primary

Addresses

Primary practice location

1500 S Lake Park Ave
Ste 110
Hobart, IN 46342-6638

Mailing address

405 Wessex Rd
Valparaiso, IN 46385-7716
Phone (219) 309-9353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20120117000646 IN Practitioner - Cardiac ElectrophysiologyPractitioner - Internal Medicine 3678740552 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Internal Medicine
Education
Indiana University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Network IncGroup PAC ID 3678737012, 378 clinicians

Practice addresses (Care Compare)

1500 S Lake Park Ave
Hobart, IN 46342-6638
Phone (219) 947-6685

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair46

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01069863AINMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Network Inc Internal Medicine CurrentSince Jul 18, 2016 Accepting new patients
Hancock Physician Network, LLC Internal Medicine Past Accepting new patients

Locations

1500 S Lake Park Ave
Hobart, IN 46342
Phone (219) 942-0551

1500 S Lake Park Ave
Ste 110
Hobart, IN 46342
Phone (219) 947-6017

9130 Columbia Ave
Ste A
Munster, IN 46321
Phone (219) 365-1166

Interoperability endpoints

  • Direct secure messaging: sajam67618@ssdirect.comhs.org

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": "1245715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465257600000",
    "number": "1467680942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 WESSEX RD",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463857716",
            "telephone_number": "219-309-9353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S LAKE PARK AVE",
            "address_2": "STE 110",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463426638",
            "telephone_number": "219-947-6017",
            "fax_number": "219-947-6018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJAM",
        "first_name": "SAMER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-23",
        "last_updated": "2016-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01069863A",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01069863A",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "IN",
            "license": "01069863A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hobart, IN

Sources for this page

Verify at the official NPI Registry.