NPIMap

Individual provider Active NPI

Reta Samimi, PA-C

  • Physician Assistant
  • Livermore, CA
National Provider Identifier
1790322253
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
57980 Issued in CA
Practice address
1133 E Stanley Blvd Ste 101
Livermore, CA 94550-4270
Phone
(925) 454-4280
Fax
(925) 454-4284
NPI assigned
Dec 4, 2019
Last updated
Jul 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Physician Assistant 363A00000X 57980 CA Primary

Addresses

Primary practice location

1133 E Stanley Blvd Ste 101
Livermore, CA 94550-4270

Mailing address

1133 E Stanley Blvd Ste 101
Livermore, CA 94550-4270
Phone (925) 454-4280

Other practice location 1

5343 Prospect Rd
San Jose, CA 95129-5033
Phone (800) 972-5547

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20200626001408 CA Practitioner - Physician Assistant 0042632671 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Healthcare AllianceGroup PAC ID 6305748799, 334 clinicians

Practice addresses (Care Compare)

1133 E Stanley Blvd
Suite 101
Livermore, CA 94550-4270
Phone (925) 454-4280

4725 1St St
Suite 100
Pleasanton, CA 94566-7366
Phone (925) 462-7060

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
57980CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Planned Parenthood Mar Monte, Inc CurrentSince Jun 1, 2020 Accepting new patients
Stanford Health Care CurrentSince May 2, 2024 Accepting new patients
Planned Parenthood Mar Monte, Inc. CurrentSince Jun 1, 2020 Accepting new patients
Planned Parenthood Mar Monte, Inc Current Accepting new patients
Stanford Health Care CurrentSince May 2, 2024 Accepting new patients
Affinity Medical Group Past Accepting new patients

Locations

1431 McHenry Ave
Ste 100
Modesto, CA 95350
Phone (209) 579-2300

4725 1st St
Ste 100
Pleasanton, CA 94566
Phone (925) 462-7060

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

4555 Precissi Ln
Stockton, CA 95207
Phone (209) 477-4103

Organizations & group practices 9

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.

Hospital & facility affiliations 1

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": "1575417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1790322253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 E STANLEY BLVD STE 101",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945504270",
            "telephone_number": "925-454-4280",
            "fax_number": "925-454-4284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 E STANLEY BLVD STE 101",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "945504270",
            "telephone_number": "925-454-4280",
            "fax_number": "925-454-4284"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5343 Prospect Rd",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951295033",
            "country_code": "US",
            "telephone_number": "800-972-5547",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMIMI",
        "first_name": "RETA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-04",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "57980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livermore, CA

Sources for this page

Verify at the official NPI Registry.