Individual provider Active NPI

Samer Hakimeh, DDS, MS

  • Pediatric Dentistry
  • Portland, OR
National Provider Identifier
1760407688
Registry record updated Jul 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D7713 Issued in OR
Practice address
1314 NE Grand Ave
Portland, OR 97232-1127
Phone
(503) 280-2877
Fax
(503) 331-3095
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X D7713 OR Primary

Addresses

Primary practice location

1314 NE Grand Ave
Portland, OR 97232-1127

Mailing address

1314 NE Grand Ave
Portland, OR 97232-1127

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110815000486 OR Order and Referring Only - DentistPractitioner - Dentist 3274702956

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
D7713ORMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Permanente 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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184284800000",
    "number": "1760407688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1314 NE GRAND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 NE GRAND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321127",
            "telephone_number": "503-280-2877",
            "fax_number": "503-331-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAKIMEH",
        "first_name": "SAMER",
        "name_prefix": "Mr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D7713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.