NPIMap

Individual provider Active NPI

Nasser Pilotin Samuy, D.O.

  • Family Medicine Physician
  • Enterprise, AL
National Provider Identifier
1710118898
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO.1093 Issued in AL
Practice address
105 E Watts St
Enterprise, AL 36330-2511
Phone
(334) 393-5437
Fax
(334) 489-4438
NPI assigned
Aug 6, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OT011895 PA
Family Medicine Physician 207Q00000X DO.1093 AL Primary

Addresses

Primary practice location

105 E Watts St
Enterprise, AL 36330-2511

Mailing address

1414 Elba Hwy
Troy, AL 36079-6020
Phone (334) 670-6726

Other identifiers 1

IdentifierTypeStateIssuer
142098MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120807000906 AL Practitioner - Family Practice 5496892895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

105 E Watts St
Enterprise, AL 36330-2511
Phone (334) 393-5437

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO.1093ALMDFamily Medicine Physician
OT011895PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alabama Rural Health Associates CurrentSince Oct 15, 2012 Accepting new patients
Southeast Alabama Rural Health Associates Current Accepting new patients
Southeast Alabama Rural Health Associates CurrentSince Oct 15, 2012 Accepting new patients
Southeast Alabama Rural Health Associates Past Accepting new patients
Vaughan Regional Medical Center LLC Family Medicine Past Accepting new patients
Southeast Alabama Rural Health Associates Past Accepting new patients

Locations

105 E Watts St
Enterprise, AL 36330
Phone (334) 393-5437

1412 Elba Hwy
Troy, AL 36079
Phone (334) 288-0814

1414 Elba Hwy
Troy, AL 36079
Phone (334) 670-6726

Interoperability endpoints

  • Direct secure messaging: nasser.samuy@sarha.eclinicaldirectplus.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1710118898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 ELBA HWY",
            "city": "TROY",
            "state": "AL",
            "postal_code": "360796020",
            "telephone_number": "334-670-6726",
            "fax_number": "334-670-6731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E WATTS ST",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302511",
            "telephone_number": "334-393-5437",
            "fax_number": "334-489-4438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUY",
        "first_name": "NASSER",
        "middle_name": "PILOTIN",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-06",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OT011895",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO.1093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142098",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enterprise, AL

Sources for this page

Verify at the official NPI Registry.