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SAMUEL DAVID FAM DO
NPI 1104211986
Family Medicine in New York, NY

Active since March 30, 2015PECOS EnrolledAccepts Medicare Assignment
1790 BROADWAY STE 1802, NEW YORK, NY 10019(212) 530-0624(212) 867-4353 Get Directions Write a Review

NPPES record last updated: April 11, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 11, 2025, Dec 6, 2018, Aug 6, 2018 (3 updates tracked since 2018).

About Samuel David Fam Do NPPES

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

SAMUEL DAVID FAM DO (NPI 1104211986) is an individual family medicine provider in New York, New York, licensed in New York (295422) and active in the NPI registry since March 2015. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Lake Erie College Of Osteopathic Medicine, Erie (2015).

NPPES Registry Identity

NPI1104211986
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameSAMUEL DAVID FAMCredential: DO
Location Address1790 BROADWAY STE 1802New York, NY 10019
Mailing Address1790 Broadway Ste 1802New York, NY 10019-1471 · (212) 530-0624 · Fax (212) 867-4353
Phone(212) 530-0624
Fax(212) 867-4353
Sole ProprietorYes
Medical School CMSLake Erie College Of Osteopathic Medicine, ErieGraduated 2015
Enumeration DateMarch 30, 2015
Last NPPES UpdateApril 11, 20253 updates tracked since enumeration
NPPES CertifiedApril 11, 2025
✔ NPI 1104211986 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Licenses✔ Licensed in NY · 295422✔ Licensed in MA · 1015332✔ Licensed in GA · 87745✔ Licensed in TX · V1769
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
1790 BROADWAY STE 1802, New York, NY 10019
Open in Google Maps ↗

Secondary Practice Locations 2

Location 12301 Erwin RdDurham, NC 27705-4699 · Phone (919) 684-8111
Location 2260 W Broadway Ste 2New York, NY 10013-2260 · Phone (212) 206-6759

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Samuel David Fam Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1951650969
PECOS Enrollment IDI20180824001536
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.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
51 services15 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
46 services34 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
37 services19 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
15 services15 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10019 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
$102.04 typical visit price
range $65.69 – $198.19
Typical copayment $25.51 (range $16.42 – $49.54)
Most-billed visit code 99203
Established Patient
$114.88 typical visit price
range $21.20 – $160.66
Typical copayment $28.72 (range $5.30 – $40.16)
Most-billed visit code 99214
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 11

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

ELAINA FRANTELLIZZI NP
Nurse Practitioner
1790 BROADWAY STE 1802
NEW YORK, NY 10019
New York County (888) 663-6331
DR. TODD COWDERY MD
Family Medicine
1790 BROADWAY STE 1802
NEW YORK, NY 10019
New York County (212) 530-0624
BRIAN HEE SANG LEE
Internal Medicine
1790 BROADWAY STE 1802
NEW YORK, NY 10019
New York County (212) 530-0624
MOUNT SINAI SCHOOL OF MEDICINE
Family Medicine
1790 BROADWAY STE 1802
NEW YORK, NY 10019
New York County (212) 530-0624
KATHERINE MACKENZIE WILLIAMS PA-C
Physician Assistant
1790 BROADWAY STE 1802
NEW YORK, NY 10019
New York County (888) 663-6331
DR. ELBERT KYLE ST CLAIRE III MD
Internal Medicine
1790 BROADWAY STE 1802
NEW YORK, NY 10019
New York County (212) 530-0624
GHAZAL REIHANI MD
Family Medicine
1790 BROADWAY STE 1802
NEW YORK, NY 10019
New York County (212) 530-0624
DR. DANIEL MARCOVICI M.D.
Internal Medicine
1790 BROADWAY STE 1802
NEW YORK, NY 10019
New York County (415) 658-6791

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 Fam's NPI number?

The NPI number for Samuel Fam is 1104211986. It was assigned to this individual provider in the NPPES registry on March 30, 2015.

Where is Samuel Fam located?

Samuel Fam practices at 1790 Broadway Ste 1802, New York, NY 10019. The listed phone number is (212) 530-0624.

What is Samuel Fam's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Samuel Fam enrolled in Medicare?

Yes. Samuel Fam is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Samuel Fam was last updated on April 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months 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.