Sidary Sam, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW94013 Issued in CA

Practice address

4510 E Pacific Coast Hwy Ste 600
Long Beach, CA 90804-6914

Phone

(562) 346-1100

NPI assigned

Jan 23, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Mr. Sidary Sam Professional name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Medical Wellness Centers USAGroup PAC ID 1759665367, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Medical Wellness Centers USA

  • Federally Qualified Health Center (FQHC)
  • Long Beach, CA
  • NPI 1235500513
  Medicare reassignment Care Compare group NPD
• Community Medical Wellness Centers USA

  • Federally Qualified Health Center (FQHC)
  • Long Beach, CA
  • NPI 1689449571
  NPD

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615161600000",
    "number": "1962557900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 E PACIFIC COAST HWY STE 600",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908046914",
            "telephone_number": "562-346-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 E PACIFIC COAST HWY STE 600",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908046914",
            "telephone_number": "562-346-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAM",
        "first_name": "SIDARY",
        "name_prefix": "Mr.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW 22278",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW94013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SIDARY",
            "last_name": "SAM",
            "prefix": "MR.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Joemari Salvani, DMD
• Catherine Salvatori
• Kathleen Ann Salvatori, COTA
• Willy Peter Salvosa-Chua, LVN
• Phaly Sam II, MS
• Sophorn Sonnie Sam
• Sam's Club Optical (Sam's Club Optical 30-6613)
• Farha Samaan, DPT
• Fawzia F Samaan, M.D.
• Amanda Samaniego

• Clinical Social Worker in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; 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.