Sam M Fassnacht

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

130 Medford Ave
Patchogue, NY 11772-1206

Phone

(631) 475-5734

NPI assigned

Sep 27, 2010

Last updated

Dec 28, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Long Island Medical Care Services PC

  • Internal Medicine Physician
  • West Babylon, NY
  • NPI 1245420249
  Medicare reassignment
• Patchogue Family Medical Care, PC

  • Family Medicine Physician
  • Patchogue, NY
  • NPI 1700915113
  Medicare reassignment
• Winthrop Community Medical Affiliates, P.C.

  dba Nassau Surgical Associates

  • Surgery Physician
  • Mineola, NY
  • NPI 1649651498
  NPD
• Physical Medicine & Rehabilitation of Long Island

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Brightwaters, NY
  • NPI 1003293366
  NPD (past)

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

{
    "created_epoch": "1285545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482883200000",
    "number": "1558670463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 MEDFORD AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 MEDFORD AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721206",
            "telephone_number": "631-475-5734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASSNACHT",
        "first_name": "SAM",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-27",
        "last_updated": "2016-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Harmonyand Personal Growth LCSW PC
• Faroqui Medical PC
• Fazal G Faroqui, DO
• Andrew Scott Farrago, D.C.
• Gina Farrell
• Jessica Fatsis, PA-C
• Mario Febbraro
• Federation of Organizations for the New York State Mentally Disabled
• Federation of Organizations for the Ny State Mentally Disabled Inc
• Audrey L Feldman, PH.D.

• Medical Physician Assistant in Patchogue, NY
• Providers in Patchogue, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; 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.