Individual provider Active NPI

Samuel Ross Donnenfeld, MD

  • Urology Physician
  • Riverside, CA
National Provider Identifier
1760045504
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A202659 Issued in CA
Practice address
10800 Magnolia Ave
Riverside, CA 92505-3043
Phone
(091) 232-7106
NPI assigned
Apr 17, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X A202659 CA Primary

Addresses

Primary practice location

10800 Magnolia Ave
Riverside, CA 92505-3043

Mailing address

1642 7TH Ave Unit 523
San Diego, CA 92101-2755
Phone (610) 937-8560

Other practice location 1

1365 Clifton Rd NE Ste B6140
Atlanta, GA 30322-1013
Phone (404) 778-4615

Other practice location 2

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 712-2000

Other practice location 3

5673 Peachtree Dunwoody Rd Ste 350
Atlanta, GA 30342-5048
Phone (404) 778-4898

Other practice location 4

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3031
Phone (404) 616-1000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251125002861 CA Practitioner - Urology 6002142882 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Utah School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

10800 Magnolia Ave
Riverside, CA 92505-3043
Phone (951) 353-2000

27300 Iris Ave
Moreno Valley, CA 92555-4802
Phone (951) 243-0811

27350 Iris Ave
Moreno Valley, CA 92555-4802
Phone (866) 984-7483

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A202659CAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Multi-Specialty CurrentSince Oct 6, 2025 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 6, 2025 Accepting new patients

Locations

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

Organizations & group practices 2

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": "1555459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753920000000",
    "number": "1760045504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1642 7TH AVE UNIT 523",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012755",
            "telephone_number": "610-937-8560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053043",
            "telephone_number": "091-232-7106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1365 Clifton Rd NE Ste B6140",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303221013",
            "country_code": "US",
            "telephone_number": "404-778-4615",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1365 Clifton Rd NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303221013",
            "country_code": "US",
            "telephone_number": "404-712-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5673 Peachtree Dunwoody Rd Ste 350",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303425048",
            "country_code": "US",
            "telephone_number": "404-778-4898",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "80 Jesse Hill Jr Dr SE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303033031",
            "country_code": "US",
            "telephone_number": "404-616-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONNENFELD",
        "first_name": "SAMUEL",
        "middle_name": "ROSS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-17",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": "CA",
            "license": "A202659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.