Individual provider Active NPI

Sami Jelousi, MD

  • General Practice Physician
  • Tucson, AZ
National Provider Identifier
1588313779
Registry record updated Jan 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
70072 Issued in AZ
Practice address
1625 N Campbell Ave
Tucson, AZ 85719-4330
Phone
(520) 694-0111
NPI assigned
Mar 23, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 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
General Practice Physician 208D00000X 70072 AZ Primary

Addresses

Primary practice location

1625 N Campbell Ave
Tucson, AZ 85719-4330

Mailing address

750 W Orange Grove Rd Apt 21104
Tucson, AZ 85704-4179

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20231103002609 AZ Practitioner - General Practice 3375990930 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
70072AZMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health, LLC General Practice CurrentSince Oct 23, 2023 Accepting new patients

Locations

2705 S Alma School Rd
Chandler, AZ 85286
Phone (480) 820-7246

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Interoperability endpoints

  • Direct secure messaging: sjelousi821834@direct.vumc.org

Organizations & group practices 1

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": "1647993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706400000000",
    "number": "1588313779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 W ORANGE GROVE RD APT 21104",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857044179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 N CAMPBELL AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857194330",
            "telephone_number": "520-694-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JELOUSI",
        "first_name": "SAMI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-23",
        "last_updated": "2024-01-28",
        "certification_date": "2024-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AZ",
            "license": "70072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.