Jay K Samak, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9111308 Issued in FL

Practice address

4435 US Highway 98 N
Lakeland, FL 33809

Phone

(863) 858-8000

NPI assigned

Jun 28, 2018

Sex

Male

Sole proprietor

No

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 NC

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Triangle Springs Physician Group LLCGroup PAC ID 7214283266, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Triangle Springs Physician Group, LLC

  • Neurology Physician
  • Raleigh, NC
  • NPI 1063901312
  Medicare reassignment Care Compare group
• Doctor Today TLC, LLC

  • Primary Care Clinic/Center
  • Lakeland, FL
  • NPI 1861689796
  NPD (past)

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1922593367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4435 US HIGHWAY 98 N",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338090402",
            "telephone_number": "863-858-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4435 US HIGHWAY 98 N",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "33809",
            "telephone_number": "863-858-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1045 US Highway 17 S",
            "address_purpose": "LOCATION",
            "city": "Bartow",
            "state": "FL",
            "postal_code": "338306027",
            "country_code": "US",
            "telephone_number": "863-858-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1429 Lakeland Hills Blvd",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338053206",
            "country_code": "US",
            "telephone_number": "863-687-0200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3810 S Florida Ave",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338131105",
            "country_code": "US",
            "telephone_number": "863-619-5100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Magnolia Ave",
            "address_purpose": "LOCATION",
            "city": "Auburndale",
            "state": "FL",
            "postal_code": "338234201",
            "country_code": "US",
            "telephone_number": "863-858-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 1st St S",
            "address_purpose": "LOCATION",
            "city": "Winter Haven",
            "state": "FL",
            "postal_code": "338803605",
            "country_code": "US",
            "telephone_number": "863-858-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "602 US Highway 17 92 N",
            "address_purpose": "LOCATION",
            "city": "Haines City",
            "state": "FL",
            "postal_code": "338449461",
            "country_code": "US",
            "telephone_number": "863-858-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMAK",
        "first_name": "JAY",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-28",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-08068",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Damaris Salmeron
• Saltzman, Tanis, Pittell, Levin and Jacobson, LLC
• Saltzman, Tanis, Pittell, Levin and Jacobson, LLC
• Sam'S Club Optical
• Sam'S Club Optical
• Srinivas P Samak, MD
• Yvette Samara, AUD
• Edwin Ashton Sammer, M.D.
• Sams East Inc
• Sams East Inc

• Physician Assistant in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; 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.
• 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.