Samuel a. Bolivar, MD Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

A41590 Issued in CA

Legal business name

SAMUEL A. BOLIVAR, MD INC

Practice address

555 N D St
Suite 130
San Bernardino, CA 92401-1305

Phone

(909) 888-8154

Fax

(909) 888-9940

NPI assigned

Aug 1, 2014

Last updated

Jul 1, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Barbara Bolivar

Title

Administrator

Phone

(909) 888-8154

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, AZ2 enrollments

Enrollment records 2

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, and the practitioner matching its NPPES authorized official.

• Samuel Antonio Bolivar, MD

  • Internal Medicine Physician
  • San Bernardino, CA
  • NPI 1144251067

  AZ

  Medicare reassignment NPD

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

{
    "created_epoch": "1406851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782864000000",
    "number": "1689082711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3410 LA SIERRA AVE",
            "address_2": "F369",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925035270",
            "telephone_number": "909-888-8154",
            "fax_number": "909-888-9940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N D ST",
            "address_2": "SUITE 130",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011305",
            "telephone_number": "909-888-8154",
            "fax_number": "909-888-9940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10600 Magnolia Ave Ste J",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925051819",
            "country_code": "US",
            "telephone_number": "951-352-3417",
            "fax_number": "951-352-3208",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 S California Ave Ste C",
            "address_purpose": "LOCATION",
            "city": "Parker",
            "state": "AZ",
            "postal_code": "853444426",
            "country_code": "US",
            "telephone_number": "928-259-1000",
            "fax_number": "909-888-9940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAMUEL A. BOLIVAR, MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-01",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A",
        "authorized_official_last_name": "BOLIVAR",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "909-888-8154"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A41590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cathy Sampson-Siriani, MSN,RN,FNP
• Ashley Sampson
• Thomas Michael Sampson
• Sams West Inc (Sams Pharmacy 10-6624)
• Nancy Samudio, MD
• Samuel J Roth, M.D., Apc
• Samuel M Sepuya MD. Inc
• Samuel Sepuya M.D. Corporation
• Alexandra Samuel-Sturgess
• Nosheen Samuel

• Primary Care Clinic/Center in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; 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.