Periasamy Samikkannu, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

1551301 Issued in NY

Practice address

45 Webster Commons Blvd
Ste 200
Webster, NY 14580-3813

Phone

(585) 872-0650

Fax

(585) 872-2474

NPI assigned

Nov 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Webster Medical Group, PC.

  • Internal Medicine Physician
  • Webster, NY
  • NPI 1609905207
  Medicare reassignment NPD

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277856000000",
    "number": "1790776342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 WEBSTER COMMONS BLVD",
            "address_2": "STE 200",
            "city": "WEBSTER",
            "state": "NY",
            "postal_code": "145803813",
            "telephone_number": "585-872-0650",
            "fax_number": "585-872-2474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 WEBSTER COMMONS BLVD",
            "address_2": "STE 200",
            "city": "WEBSTER",
            "state": "NY",
            "postal_code": "145803813",
            "telephone_number": "585-872-0650",
            "fax_number": "585-872-2474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMIKKANNU",
        "first_name": "PERIASAMY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2010-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "1551301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Sabourin, PT, DPT
• Daniel Safee
• Abigail Joy Salico, PHARMD, RPH
• William F. Salminen, D.D.S.
• Samantha Green Licensed Mental Health Counseling PLLC
• Sara Beth Henley Sands, LMSW
• Carl M Santo, DDS
• Carrie Santore, DC, CFMP
• Frank J Sapere, DDS
• Carol Anne Sapp, LPN

• Internal Medicine Physician in Webster, NY
• Providers in Webster, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.