Samer S Sannoufi, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD33024 Issued in AZ

Practice address

6900 Brockton Ave Ste 200
Riverside, CA 92506

Phone

(951) 682-6263

Fax

(951) 682-0114

NPI assigned

Apr 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Medex Health Care LLC

  • Primary Care Clinic/Center
  • Gilbert, AZ
  • NPI 1023201464
  NPD (past) Authorized official
• Jack B Kistler MD Inc

  • Primary Care Clinic/Center
  • Riverside, CA
  • NPI 1457676249
  NPD (past)
• Emcare Physician Providers, Inc

  • Emergency Medicine Physician
  • Winslow, AZ
  • NPI 1144270315
  NPD (past)
• Emergency Medical Solutions, LTD.

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1245488519
  NPD (past)
• Kirkland Healthcare Systems, P.C.

  • Rehabilitation Chiropractor
  • Gilbert, AZ
  • NPI 1033314547

  Family Medicine

  NPD (past)
• Little Colorado Emergency Physicians LLC

  • Emergency Medicine Physician
  • Winslow, AZ
  • NPI 1457363418
  NPD (past)
• Mesa General Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1568473940
  NPD (past)

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577404800000",
    "number": "1528023264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 BROCKTON AVE STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063818",
            "telephone_number": "951-682-6263",
            "fax_number": "951-682-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 BROCKTON AVE STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92506",
            "telephone_number": "951-682-6263",
            "fax_number": "951-682-0114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 W Guadalupe Rd",
            "address_2": "Ste 311",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "85233",
            "country_code": "US",
            "telephone_number": "480-558-7078",
            "fax_number": "480-558-7081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANNOUFI",
        "first_name": "SAMER",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "MD33024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA MEDICAL BOARD",
            "identifier": "C53604",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sumedh Sanghdeep
• Tassaporn Sangkijporn, DO
• Sandeep Chandu Sangodkar, D.O.
• Chanchai Sangsurasak, D.D.S
• Nicole Ann Sanguino, PT, DPT
• Angelica Santacruz
• Laura Janet Santamaria
• Noel Santamaria, PA
• Adriana Santana, CMT
• Jessielizbeth Santana

• Family Medicine Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.