Amir Azarisamani, MD, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D9793 Issued in OR

Practice address

1893 NE Neff Rd
Bend, OR 97701-6112

Phone

(541) 382-7981

NPI assigned

Apr 4, 2012

Last updated

Aug 27, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Amir Farhad Azarisamani Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Aug 28, 2019 through Aug 28, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Facial and Oral Surgery Center LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Bend, OR
  • NPI 1801483318
  NPD Authorized official
• Todd a Schock PC DMD MD

  • Oral and Maxillofacial Surgery Clinic/Center
  • Bend, OR
  • NPI 1285744573
  NPD (past)

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

{
    "created_epoch": "1333497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1598021578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1893 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016112",
            "telephone_number": "541-382-7981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1893 NE NEFF RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016112",
            "telephone_number": "541-382-7981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZARISAMANI",
        "first_name": "AMIR",
        "credential": "MD, DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-04",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN19828",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D9793",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "OR",
            "license": "MD187266",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON BOARD OF DENTISTRY",
            "identifier": "D9793",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON BOARD OF MEDICINE",
            "identifier": "MD187266",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMIR",
            "last_name": "AZARISAMANI",
            "middle_name": "FARHAD",
            "credential": "MD, DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jordan Avila
• Awbrey Dental Group PC
• Karen Langer Axten, M.D.
• Shawn D Axten, PT,CST-D
• Patrick Ayres, O.D.
• Michael Daniel Azevedo
• Gregg Darius Azin, MD
• Paula Babb
• Babin Family Care LLC (Home Helpers Home Care of Bend Or)
• Julia Babjack

• Oral and Maxillofacial Surgery (Dentist) in Bend, OR
• Providers in Bend, OR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.