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SAMUEL TACK
NPI 1033658406
Dentist - Oral and Maxillofacial Surgery in Richmond, VA

Active since February 18, 2017PECOS Enrolled
520 N 12TH ST, RICHMOND, VA 23298(804) 628-7146 Get Directions Write a Review

NPPES record last updated: September 11, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jan 15, 2018, Feb 18, 2017 (2 updates tracked since 2017).

About Samuel Tack NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMUEL TACK (NPI 1033658406) is an individual oral and maxillofacial surgery provider in Richmond, Virginia, licensed in Virginia (0438000489) and active in the NPI registry since February 2017. He is enrolled in Medicare PECOS and maintains a secondary practice location in New Hyde Park.

NPPES Registry Identity

NPI1033658406
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameSAMUEL TACK
Location Address520 N 12TH STRichmond, VA 23298-5064
Mailing Address520 N 12th StRichmond, VA 23298-5064 · (804) 628-7146
Phone(804) 628-7146
Sole ProprietorYes
Enumeration DateFebruary 18, 2017
Last NPPES UpdateSeptember 11, 20232 updates tracked since enumeration
NPPES CertifiedSeptember 11, 2023
✔ NPI 1033658406 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in VA · 0438000489
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X · License 0401415733 (VA)
520 N 12TH ST, Richmond, VA 23298
Open in Google Maps ↗

Secondary Practice Location 1

Location 127005 76th AveNew Hyde Park, NY 11040-1402 · Phone (718) 470-7000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel Tack is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Samuel Tack reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Vcu Oral-Facial Surgery And Services LLC
Same address
Oral & Maxillofacial Surgery
520 N 12TH ST
Richmond, VA 23298
  • Reassigned Medicare billing, Virginia enrollment
  • 16 clinicians in this Medicare group
NPI 1215502125 (804) 628-6637
North Pittsburgh Oral Surgery Assoc Ltd
252 mi
Oral and Maxillofacial Surgery
9380 MCKNIGHT ROAD, SUITE 203
Pittsburgh, PA 15237
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 9 clinicians in this Medicare group
NPI 1659556728 (412) 367-3222

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 23298 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$86.88 typical visit price
range $56.19 – $170.30
Typical copayment $21.72 (range $14.04 – $42.57)
Most-billed visit code 99203
Established Patient
$70.08 typical visit price
range $18.07 – $138.91
Typical copayment $17.52 (range $4.51 – $34.72)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SHAHRZAD ORENDUFF D.D.S.
Dentist (General Practice)
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 828-9190
DR. JESSICA GILL DDS
Dentist
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 571-0357
DR. DEAN M DELUKE DDS
Oral & Maxillofacial Surgery
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 628-6637
BRANDON KHOR
Student in an Organized Health Care Education/Training Program
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 828-9190
ALI REZA MOJARAD DDS
Dentist
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 828-9190
WILLIAM BANKS LEE DMD
Student in an Organized Health Care Education/Training Program
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 828-9190
DR. NITYA REDDY DDS
Dentist (Periodontics)
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 828-9356
VCU
Dentist (Periodontics)
520 N 12TH ST
RICHMOND, VA 23298
Richmond City (804) 828-9190

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel Tack's NPI number?

The NPI number for Samuel Tack is 1033658406. It was assigned to this individual provider in the NPPES registry on February 18, 2017.

Where is Samuel Tack located?

Samuel Tack practices at 520 N 12th St, Richmond, VA 23298. The listed phone number is (804) 628-7146.

What is Samuel Tack's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Samuel Tack enrolled in Medicare?

Yes. Samuel Tack is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Samuel Tack's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Tack reassigns Medicare benefits to 2 organizations: Vcu Oral-Facial Surgery And Services LLC (Richmond, VA) and North Pittsburgh Oral Surgery Assoc Ltd (Pittsburgh, PA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samuel Tack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Samuel Tack accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Dominion National and 3 other insurers list Samuel Tack as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Samuel Tack was last updated on September 11, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.