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MRS. NISRIN ABDELSAMIE FNP
NPI 1104360627
Nurse Practitioner - Family in Montclair, CA

Active since December 19, 2016PECOS Enrolled
4950 SAN BERNARDINO ST STE 218, MONTCLAIR, CA 91763(714) 785-3495 Get Directions Write a Review

NPPES record last updated: December 6, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 6, 2021, Dec 19, 2016 (2 updates tracked since 2016).

About Mrs. Nisrin Abdelsamie Fnp NPPES

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

MRS. NISRIN ABDELSAMIE FNP (NPI 1104360627) is an individual family provider in Montclair, California, licensed in California (95005663) and active in the NPI registry since December 2016. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104360627
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMRS. NISRIN ABDELSAMIECredential: FNP
Location Address4950 SAN BERNARDINO ST STE 218Montclair, CA 91763-2328
Mailing Address4950 San Bernardino St Ste 218Montclair, CA 91763-2328 · (714) 785-3495
Phone(714) 785-3495
Sole ProprietorNo
Enumeration DateDecember 19, 2016
Last NPPES UpdateDecember 6, 20212 updates tracked since enumeration
✔ NPI 1104360627 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in CA · 95005663
4950 SAN BERNARDINO ST STE 218, Montclair, CA 91763
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Nisrin Abdelsamie Fnp 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

3

Medicare enrollment records show Nisrin Abdelsamie reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Faculty Physicians And Surgeons Of Llusm
3.3 mi
Pediatric Cardiology
1101 N EUCLID AVE
Upland, CA 91786
  • Reassigned Medicare billing, California enrollment
  • 2,584 clinicians in this Medicare group
NPI 1912343104 (909) 558-4000
Pih Health Physicians
3.9 mi
Interventional Cardiology
685 N 13TH AVE STE 9
Upland, CA 91786
  • Reassigned Medicare billing, California enrollment
  • 840 clinicians in this Medicare group
NPI 1437815313 (909) 949-3977
Southern California Permanente Medical Group
5.0 mi
Clinical Medical Laboratory
13000 PEYTON DR
Chino Hills, CA 91709
  • Reassigned Medicare billing, California enrollment
  • Also billed through NPI 1770515280 (California)
  • 5,228 clinicians in this Medicare group
NPI 1396287082 (888) 750-0036

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 91763 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
$91.88 typical visit price
range $59.60 – $179.42
Typical copayment $22.97 (range $14.90 – $44.85)
Most-billed visit code 99203
Established Patient
$104.64 typical visit price
range $19.37 – $146.42
Typical copayment $26.16 (range $4.84 – $36.60)
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

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

PERLA KELENJIAN
Nurse Practitioner (Family)
4950 SAN BERNARDINO ST STE 218
MONTCLAIR, CA 91763
San Bernardino County (909) 624-8019

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 Nisrin Abdelsamie's NPI number?

The NPI number for Nisrin Abdelsamie is 1104360627. It was assigned to this individual provider in the NPPES registry on December 19, 2016.

Where is Nisrin Abdelsamie located?

Nisrin Abdelsamie practices at 4950 San Bernardino St Ste 218, Montclair, CA 91763. The listed phone number is (714) 785-3495.

What is Nisrin Abdelsamie's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Nisrin Abdelsamie enrolled in Medicare?

Yes. Nisrin Abdelsamie is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Nisrin Abdelsamie's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nisrin Abdelsamie reassigns Medicare benefits to 3 organizations: Faculty Physicians And Surgeons Of Llusm (Upland, CA), Pih Health Physicians (Upland, CA) and Southern California Permanente Medical Group (Chino Hills, CA). 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 Nisrin Abdelsamie's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Nisrin Abdelsamie was last updated on December 6, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.