South Side Convenient Care Inc

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

SOUTH SIDE CONVENIENT CARE INC

Practice address

4115 Harrison St
Bellevue, NE 68147-1059

Phone

(402) 932-0692

Fax

(402) 614-6731

NPI assigned

Apr 20, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Samantha Senanayaka, PA-CNPI 1912241506

Title

Clinic Credentialing Contact

Phone

(402) 350-7616

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samantha Senanayaka, MPAS, PA-C

  • Physician Assistant
  • Bellevue, NE
  • NPI 1912241506
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1679007249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 HARRISON ST",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "681471059",
            "telephone_number": "402-932-0692",
            "fax_number": "402-614-6731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 HARRISON ST",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "681471059",
            "telephone_number": "402-932-0692",
            "fax_number": "402-614-6731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SIDE CONVENIENT CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-20",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "SENANAYAKA",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CLINIC CREDENTIALING CONTACT",
        "authorized_official_telephone_number": "402-350-7616",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026666300",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aiden Joseph Sortino
• Candice Sortino
• Arely Sotelo-Trujillo
• Daisy Sotelo
• Naylah Soto
• Joseph William South
• Marvilyn Southward
• Nicole Sova, PT
• Kelly Spath, RN
• Spectrum Mental Wellness LLC

• Physician Assistant in Bellevue, NE
• Providers in Bellevue, NE by specialty
• Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.