Sammy Joseph Leos, PA-C, DSC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA2014004 Issued in NM

Practice address

5955 Zeamer Ave
Elmendorf Afb, AK 99506-3702

Phone

(907) 580-1243

NPI assigned

Nov 25, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1385337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679011200000",
    "number": "1689004855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "673 MEDICAL GROUP",
            "address_2": "5955 ZEAMER AVE",
            "city": "JBER",
            "state": "AK",
            "postal_code": "99506",
            "telephone_number": "907-580-1243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 ZEAMER AVE",
            "city": "ELMENDORF AFB",
            "state": "AK",
            "postal_code": "995063702",
            "telephone_number": "907-580-1243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEOS",
        "first_name": "SAMMY",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "PA-C, DSC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-25",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NM",
            "license": "PA2014004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald Michael Kichura, O.D.
• Jeanette Katharine Klamfoth, D.O.
• Winifred Gail Koehler, WHCNP
• Megan Kimberly Kruty, M.A.
• Raymond Joseph Legenza Jr., MD
• Christi Marie Logan, R.D.
• Jesse A Lopez, IDMT
• Richard Michael Luff, D.D.S.
• Vicki Ann Lumley, PH.D.
• Jonathan Madden, M.D.

• Surgical Physician Assistant in Elmendorf Afb, AK
• Providers in Elmendorf Afb, AK by specialty
• Surgical Physician Assistant in Alaska

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

Verify at the official NPI Registry.