Individual provider Active NPI

Samuel Alfred Shahidi, M.S., PA-C

  • Surgical Physician Assistant
  • Bronx, NY
National Provider Identifier
1922314632
Registry record updated Aug 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
014108 Issued in NY
Practice address
234 E 149TH St
Bronx, NY 10451-5504
Phone
(718) 579-5000
NPI assigned
Aug 19, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 014108 NY Primary

Addresses

Primary practice location

234 E 149TH St
Bronx, NY 10451-5504

Mailing address

515 Lindberg Ave
Cliffside Park, NJ 07010-2203
Phone (201) 840-9654

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110719000549 NY Practitioner - Physician Assistant 0345418398 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Rutgers New Jersey Medical School, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Affiliate Group of New York PCGroup PAC ID 4688098833, 1,222 clinicians

Practice addresses (Care Compare)

234 E 149 St
Bronx, NY 10451-5504
Phone (718) 579-6101

2601 Ocean Pkwy
Brooklyn, NY 11235-7745
Phone (718) 616-5356

Hospital & facility affiliations

  • Lincoln Medical & Mental Health Center Hospital, Bronx, NY, CCN 330080

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York City Health and Hospitals Corporation Past Accepting new patients

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: sshahidi839440@nychhc.direct-ci.com

Organizations & group practices 3

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.

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": "1282176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282176000000",
    "number": "1922314632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 LINDBERG AVE",
            "city": "CLIFFSIDE PARK",
            "state": "NJ",
            "postal_code": "070102203",
            "telephone_number": "201-840-9654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 E 149TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104515504",
            "telephone_number": "718-579-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHIDI",
        "first_name": "SAMUEL",
        "middle_name": "ALFRED",
        "name_prefix": "Mr.",
        "credential": "M.S., PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-19",
        "last_updated": "2010-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "014108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.