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SAM MAVIS
NPI 1043738370
Student in an Organized Health Care Education/Training Program in Pacoima, CA

Active since September 07, 2017Opted out of Medicare · through Sep 1, 2026
12450 VAN NUYS BLVD, PACOIMA, CA 91331(818) 896-1161(818) 896-5069 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Sam Mavis NPPES

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

SAM MAVIS (NPI 1043738370) is an individual student in an organized health care education/training program in Pacoima, California and active in the NPI registry since September 2017. She has opted out of Medicare through September 1, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1043738370
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameSAM MAVIS
Location Address12450 VAN NUYS BLVDPacoima, CA 91331-1391
Mailing Address12450 Van Nuys BlvdPacoima, CA 91331-1391 · (818) 896-1161 · Fax (818) 896-5069
Phone(818) 896-1161
Fax(818) 896-5069
Sole ProprietorNo
Enumeration DateSeptember 7, 2017
Last NPPES UpdateJuly 21, 2022
✔ NPI 1043738370 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

12450 VAN NUYS BLVD, Pacoima, CA 91331
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Other Identifiers 3

Medicaid6758CA
Medicaid7420CA
Medicaid7068CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Sam Mavis has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 1, 2024 through September 1, 2026.

Opt-Out Effective DateSeptember 1, 2024
Opt-Out In Effect ThroughSeptember 1, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

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.

CESAR FRANCO
Case Manager/Care Coordinator
12450 VAN NUYS BLVD, SUITE 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
MRS. SUE NOVACK SORENSEN LCSW
Social Worker (Clinical)
12450 VAN NUYS BLVD, 100
PACOIMA, CA 91331
Los Angeles County (818) 896-8366
VALENTINA USUBYAN
Counselor (Mental Health)
12450 VAN NUYS BLVD
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
MARIA DIAZ
Peer Specialist
12450 VAN NUYS BLVD, 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
MR. VERNON WOLF WINDELL MFT
Marriage & Family Therapist
12450 VAN NUYS BLVD, SUITE 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
ELENA KARENEV
Counselor (Mental Health)
12450 VAN NUYS BLVD, SUITE 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
ELANI TUCHMAN M.A.
Psychologist (Clinical)
12450 VAN NUYS BLVD, SUITE 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161
DR. MELISSA DIANE BOUDIN PSY.D.
Psychologist (Clinical)
12450 VAN NUYS BLVD, SUITE 200
PACOIMA, CA 91331
Los Angeles County (818) 896-1161

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 Sam Mavis's NPI number?

The NPI number for Sam Mavis is 1043738370. It was assigned to this individual provider in the NPPES registry on September 7, 2017.

Where is Sam Mavis located?

Sam Mavis practices at 12450 Van Nuys Blvd, Pacoima, CA 91331. The listed phone number is (818) 896-1161.

What is Sam Mavis's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Sam Mavis enrolled in Medicare?

No. Sam Mavis has opted out of Medicare through September 1, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Sam Mavis was last updated on July 21, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.