NPIMap

Individual provider Active NPI

Samuel Harris, D.O.

  • Internal Medicine Physician
  • Sunrise, FL
National Provider Identifier
1750813895
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS15623 Issued in FL
Practice address
12651 W Sunrise Blvd Ste 202
Sunrise, FL 33323-0906
Phone
(954) 838-8801
Fax
(954) 838-8807
NPI assigned
Mar 29, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X OS15623 FL Primary

Addresses

Primary practice location

12651 W Sunrise Blvd Ste 202
Sunrise, FL 33323-0906

Mailing address

2001 W 68TH St
Ste 202
Hialeah, FL 33016-1801
Phone (305) 364-2107

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20200611002518 FL Practitioner - Internal Medicine 1557648060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Nova Southeastern College of Osteo Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Multispecialtyhealthcare LLCGroup PAC ID 7012347347, 7 clinicians

Practice addresses (Care Compare)

1480 N University Dr
Coral Springs, FL 33071-6040
Phone (954) 840-0530

Hospital & facility affiliations

  • All County Health Care, Inc Home health agency, Lauderdale Lakes, FL, CCN 109250
  • Medi-Nurse Home health agency, Miami, FL, CCN 109505
  • Broward Health Coral Springs Hospital, Coral Springs, FL, CCN 100276
  • Boca Raton Regional Hospital Hospital, Boca Raton, FL, CCN 100168
  • Holy Cross Hospital Hospital, Ft Lauderdale, FL, CCN 100073

Merit-based Incentive Payment System (MIPS)

Final score
91.81 of 100Reported as group
Quality
100
Promoting interoperability
100
Improvement activities
40
Cost
72.71

Merit-based Incentive Payment System (MIPS)

Final score
88.26 of 100Reported as group
Quality
98.43
Promoting interoperability
99
Improvement activities
40
Cost
61.11

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Multispecialtyhealthcare LLC Internal Medicine CurrentSince Jan 1, 2024 Accepting new patients
Palm Beach General Surgery LLC PastSince Jun 14, 2020 Accepting new patients
Columbia Primary Care LLC Internal Medicine PastSince Jan 1, 2024 Accepting new patients

Locations

1001 Wynmoor Cir
Ste 120
Coconut Creek, FL 33066
Phone (954) 840-0530

1480 N University Dr
Coral Springs, FL 33071
Phone (954) 753-1030

1881 N University Dr
Ste 110
Coral Springs, FL 33071
Phone (954) 289-4777

Interoperability endpoints

  • Direct secure messaging: samuel.harris.1@24763.direct.athenahealth.com

Organizations & group practices 3

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 8

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": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1750813895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 W 68TH ST",
            "address_2": "STE 202",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330161801",
            "telephone_number": "305-364-2107",
            "fax_number": "305-822-8347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12651 W SUNRISE BLVD STE 202",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333230906",
            "telephone_number": "954-838-8801",
            "fax_number": "954-838-8807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "SAMUEL",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-29",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS15623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunrise, FL

Sources for this page

Verify at the official NPI Registry.