NPIMap

Individual provider Active NPI

Richard Aaron Samudia, PA-C, MSPAS, MPH

  • Surgical Physician Assistant
  • Fresno, CA
National Provider Identifier
1881970077
Registry record updated Feb 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA22017 Issued in CA
Practice address
2335 E Kashian LN
Suite 301
Fresno, CA 93701-2230
Phone
(559) 320-0530
Fax
(559) 320-0532
NPI assigned
Nov 1, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA22017 CA Primary
Physician Assistant 363A00000X PA22017 CA

Addresses

Primary practice location

2335 E Kashian LN
Suite 301
Fresno, CA 93701-2230

Mailing address

4910 E Clinton Way
Suite 101
Fresno, CA 93727-1560
Phone (559) 443-2682

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
I20120402000239 CA Practitioner - Physician Assistant 8022278860 Reassigns benefits to 11 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22017CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California CurrentSince Oct 1, 2014 Accepting new patients
Cep America - California CurrentSince Aug 1, 2013 Accepting new patients
Orange County Urgent Care #3, Inc. CurrentSince May 1, 2015 Accepting new patients
Sunrise Medical Associates Inc Past Accepting new patients

Locations

2415 E Imperial Hwy
Brea, CA 92821
Phone (714) 255-1640

12601 Garden Grove Blvd
Garden Grove, CA 92843
Phone (714) 537-5160

115 Mall Dr
Hanford, CA 93230
Phone (559) 537-0550

78965 Highway 111
Ste 100
La Quinta, CA 92253
Phone (706) 777-7847

2010 E Carson St
Long Beach, CA 90807
Phone (213) 401-0371

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1320105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360800000000",
    "number": "1881970077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 E CLINTON WAY",
            "address_2": "SUITE 101",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937271560",
            "telephone_number": "559-443-2682",
            "fax_number": "559-443-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2335 E KASHIAN LN",
            "address_2": "SUITE 301",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937012230",
            "telephone_number": "559-320-0530",
            "fax_number": "559-320-0532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUDIA",
        "first_name": "RICHARD",
        "middle_name": "AARON",
        "credential": "PA-C, MSPAS, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-01",
        "last_updated": "2013-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA22017",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA22017",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.