Federico Samortin Doctor Jr., M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A101104 Issued in CA

Practice address

5342 Dudley Blvd
McClellan, CA 95652-1012

Phone

(916) 561-7400

Fax

(916) 561-7405

NPI assigned

Dec 12, 2006

Last updated

Oct 23, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193097600000",
    "number": "1790846129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8301 W CHARLESTON BLVD",
            "address_2": "APT.2066",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891179068",
            "telephone_number": "702-577-3027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5342 DUDLEY BLVD",
            "city": "MCCLELLAN",
            "state": "CA",
            "postal_code": "956521012",
            "telephone_number": "916-561-7400",
            "fax_number": "916-561-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOCTOR",
        "first_name": "FEDERICO",
        "middle_name": "SAMORTIN",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "242423",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A101104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destiny Dawley
• Jody Lynn Decker, PPSC
• Cesia E Del Cid
• Anna Depello
• Rino Dizon, DO
• Mae Ruth Doctor, NP
• Kim Duke
• Jasmine Elliott
• Emilce Integrative Care, a Psychological Corporation
• Kyra Ivanna Evans-Greagor

• Family Medicine Physician in McClellan, CA
• Providers in McClellan, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; 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.