NPIMap

Organization Active NPI

Sierra Madre Community Medical Group, Inc

  • Internal Medicine Physician
  • Sierra Madre, CA
National Provider Identifier
1902951825
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SIERRA MADRE COMMUNITY MEDICAL GROUP, INC
Practice address
147 W Sierra Madre Blvd
Sierra Madre, CA 91024-2492
Phone
(626) 355-3443
Fax
(626) 355-7843
NPI assigned
Jan 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Authorized official

Name
Hani Sami, MDNPI 1306891957
Title
President/ Physician
Phone
(626) 921-1808

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

147 W Sierra Madre Blvd
Sierra Madre, CA 91024-2492

Mailing address

147 W Sierra Madre Blvd
Sierra Madre, CA 91024-2492
Phone (626) 355-3443

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ606482OtherCABLUE SHIELD
GR0087460MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041022001121 CA Part B Supplier - Clinic/Group Practice 8729049663 Receives reassigned benefits from 8 practitioners
Practice locations: Sierra Madre, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0978847Sierra Madre Community Medical GRP Inc147 West Sierra Madre Boulevard, Sierra Madre, CA 91024Certificate of waiverOct 3, 2026

National Provider Directory

National Provider Directory

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1902951825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 W SIERRA MADRE BLVD",
            "city": "SIERRA MADRE",
            "state": "CA",
            "postal_code": "910242492",
            "telephone_number": "626-355-3443",
            "fax_number": "626-355-7843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 W SIERRA MADRE BLVD",
            "city": "SIERRA MADRE",
            "state": "CA",
            "postal_code": "910242492",
            "telephone_number": "626-355-3443",
            "fax_number": "626-355-7843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIERRA MADRE COMMUNITY MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "SAMI",
        "authorized_official_first_name": "HANI",
        "authorized_official_title_or_position": "PRESIDENT/ PHYSICIAN",
        "authorized_official_telephone_number": "626-921-1808",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ606482",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0087460",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Madre, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.