Organization Active NPI

Samuel Loredo MD Inc

  • Obstetrics & Gynecology Physician
  • Merced, CA
National Provider Identifier
1568651040
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
G55263 Issued in CA
Legal business name
SAMUEL LOREDO MD INC
Practice address
139 W El Portal Drive Ste a
Merced, CA 95348-2844
Phone
(209) 722-2716
Fax
(209) 722-2767
NPI assigned
Oct 19, 2007
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Dr. Samuel Loredo MD, MD
Title
Physician
Phone
(209) 722-2716

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X G55263 CA Primary

Addresses

Primary practice location

139 W El Portal Drive Ste a
Merced, CA 95348-2844

Mailing address

139 W El Portal Dr
Merced, CA 95348-2844
Phone (209) 722-2716

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071208000210 CA Part B Supplier - Clinic/Group Practice 3274622584 Receives reassigned benefits from 1 practitioner
Practice locations: Merced, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0713153Samuel Loredo MD Inc139 W El Portal Dr #a, Merced, CA 95348Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

139 W El Portal Dr
Merced, CA 95348
Phone (209) 722-2716

139 W El Portal Dr
Ste A
Merced, CA 95348
Phone (209) 722-2716

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1568651040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 W EL PORTAL DR",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953482844",
            "telephone_number": "209-722-2716",
            "fax_number": "209-722-2767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 W EL PORTAL DRIVE STE A",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953482844",
            "telephone_number": "209-722-2716",
            "fax_number": "209-722-2767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL LOREDO MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-19",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "LOREDO MD",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "209-722-2716",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G55263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Merced, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.