Samuel Louis Bobek, DMD, MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

MD60495614 Issued in WA

Practice address

600 Broadway Ste 460
Seattle, WA 98122-5312

Phone

(206) 207-1525

Fax

(206) 207-1625

NPI assigned

May 10, 2007

Last updated

Feb 29, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 28, 2024 through Feb 29, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: sbobek292420@wm.providencedirect.org

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

• Samuel Bobek PLLC

  dba Seattle Jaw Surgery

  • Dental Clinic/Center
  • Seattle, WA
  • NPI 1841833431
  Authorized official Same address or phone

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582934400000",
    "number": "1720292436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 BROADWAY STE 460",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981225312",
            "telephone_number": "206-207-1525",
            "fax_number": "206-207-1625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 BROADWAY STE 460",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981225312",
            "telephone_number": "206-207-1525",
            "fax_number": "206-207-1625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOBEK",
        "first_name": "SAMUEL",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2020-02-29",
        "certification_date": "2020-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "WA",
            "license": "MD60495614",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE60497405",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bob Johnsons Pharmacy Inc
• Bob's Psychotherapy
• Valerie L Bobb, PHYSICAL THERAPIST
• Bobbi M. Smith Counseling
• Bobby L. Butler, DDS PLLC
• Hailey Elizabeth Bobin Cole, RN
• Ashley R Bobman
• Katherine Bobo, RN
• Raffael Boccamazzo
• Ashley Rose Bocek, CBT

• Oral & Maxillofacial Surgery (D.M.D.) in Seattle, WA
• Providers in Seattle, WA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.