Individual provider Active NPI

Samuel David Sanders III, M.D.

  • Psychiatry Physician
  • Torrance, CA
National Provider Identifier
1558725143
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A154658 Issued in CA
Practice address
21535 Hawthorne Blvd Ste 200
Torrance, CA 90503-6612
Phone
(424) 284-2440
NPI assigned
Apr 8, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X A154658 CA Primary

Addresses

Primary practice location

21535 Hawthorne Blvd Ste 200
Torrance, CA 90503-6612

Mailing address

21535 Hawthorne Blvd Ste 200
Torrance, CA 90503-6612

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20201029001922 CA Practitioner - Psychiatry 8224448477 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Louisville School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Practice addresses (Care Compare)

21535 Hawthorne Blvd
Suite 200
Torrance, CA 90503-6612
Phone (925) 282-1778

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A154658CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Los Angeles County Department of Mental Health Current Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Jul 27, 2020 Accepting new patients
Pacific Coast Psychiatric Associates Inc Psychiatry CurrentSince Sep 16, 2024 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Jul 27, 2020 Accepting new patients

Locations

550 S Vermont Ave
Fl 6
Los Angeles, CA 90020
Phone (213) 351-7284

6200 Wilshire Blvd
Ste 1410
Los Angeles, CA 90048
Phone (323) 403-0474

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

1294 W 6th St
Fl 2
San Pedro, CA 90731
Phone (310) 519-6100

21535 Hawthorne Blvd
Ste 200
Torrance, CA 90503
Phone (925) 744-6013

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.samuelsanders@148377.advancedmd-direct.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1460073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1558725143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21535 HAWTHORNE BLVD STE 200",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905036612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21535 HAWTHORNE BLVD STE 200",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905036612",
            "telephone_number": "424-284-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "SAMUEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-08",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A154658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Torrance, CA

Sources for this page

Verify at the official NPI Registry.