Active NPI
Sams East Inc
- Community/Retail Pharmacy
- Apopka, FL
National Provider Identifier
1699154161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PH29210
- Legal business name
- SAMS EAST INC
- Doing business as
- Sam's Club Pharmacy 10-6189
- Practice address
- 1500 S Orange Blossom TRL
Apopka, FL 32703 - Phone
- (407) 553-4108
- Fax
- (407) 553-4107
- NPI assigned
- May 29, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Laura Levine
- Title
- Dir Healthcare Contracting
- Phone
- (479) 204-8550
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | PH29210 | FL | Primary |
Addresses
Primary practice location
1500 S Orange Blossom TRL
Apopka, FL 32703
Mailing address
702 SW 8TH St
Mailstop 0445
Bentonville, AR 72716-6209
Phone (479) 204-8550
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 014113801 DME | Medicaid | FL | |
| 015339101 DME | Medicaid | FL | |
| 015339100 | Medicaid | FL | |
| 014113800 | Medicaid | FL | |
| 2152268 | Other | PK |
Other names 1
- Sam's Club Pharmacy 10-6189
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150918001905 | FL | DME Supplier - Pharmacy | 7012038581 | Practice locations: Apopka, FL |
National Provider Directory
National Provider DirectoryMember of 2
Organizations this organization is a member of, according to the National Provider Directory.
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432857600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1693267200000",
"number": "1699154161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 SW 8TH ST",
"address_2": "MAILSTOP 0445",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727166209",
"telephone_number": "479-204-8550",
"fax_number": "479-277-4331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 S ORANGE BLOSSOM TRL",
"city": "APOPKA",
"state": "FL",
"postal_code": "32703",
"telephone_number": "407-553-4108",
"fax_number": "407-553-4107"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAMS EAST INC",
"organizational_subpart": "NO",
"enumeration_date": "2015-05-29",
"last_updated": "2023-08-29",
"certification_date": "2023-08-29",
"status": "A",
"authorized_official_last_name": "LEVINE",
"authorized_official_first_name": "LAURA",
"authorized_official_title_or_position": "DIR HEALTHCARE CONTRACTING",
"authorized_official_telephone_number": "479-204-8550"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "FL",
"license": "PH29210",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "014113801 DME",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "015339101 DME",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "015339100",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "014113800",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2152268",
"state": null
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "Ability Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "100 N 6th St Ste 900A",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031516",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Sam's Club Pharmacy 10-6189",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Sam's Club Pharmacy 10-6189",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Apopka, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.