Active NPI
Bruce Samarian, M.D.
- Internal Medicine Physician
- Berkley, MI
National Provider Identifier
1720002090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 4301039672
- Practice address
- 1695 W. 12 Mile Road
Suite 200
Berkley, MI 48072-2100 - Phone
- (248) 548-9090
- Fax
- (248) 548-8462
- NPI assigned
- Jul 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301039672 | MI | Primary |
Addresses
Primary practice location
1695 W. 12 Mile Road
Suite 200
Berkley, MI 48072-2100
Mailing address
1695 W. 12 Mile Road
Suite 200
Berkley, MI 48072-2100
Phone (248) 548-9090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 281860 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SJMH Medical Practice-SMHC | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720002090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1695 W. 12 MILE ROAD",
"address_2": "SUITE 200",
"city": "BERKLEY",
"state": "MI",
"postal_code": "480722100",
"telephone_number": "248-548-9090",
"fax_number": "248-548-8462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1695 W. 12 MILE ROAD",
"address_2": "SUITE 200",
"city": "BERKLEY",
"state": "MI",
"postal_code": "480722100",
"telephone_number": "248-548-9090",
"fax_number": "248-548-8462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMARIAN",
"first_name": "BRUCE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301039672",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "281860",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berkley, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.