1. Home
  2. Directory
  3. Nevada
  4. Las Vegas
  5. Nurse Practitioner
  6. NPI Profile

MR. SAMUEL HOUSTON LANE V
NPI 1104628940
Nurse Practitioner - Family in Las Vegas, NV

Active since March 25, 2025PECOS EnrolledAccepts Medicare Assignment
9785 S MARYLAND PKWY STE 2, LAS VEGAS, NV 89183(702) 474-0077 Get Directions Write a Review

NPPES record last updated: November 19, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 19, 2025, Mar 25, 2025 (2 updates tracked since 2025).

About Mr. Samuel Houston Lane V NPPES

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

MR. SAMUEL HOUSTON LANE V (NPI 1104628940) is an individual family provider in Las Vegas, Nevada, licensed in Nevada (888784) and active in the NPI registry since March 2025. He is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1104628940
Entity TypeIndividualMale
Primary Taxonomy363LF0000X
Provider Legal NameMR. SAMUEL HOUSTON LANE V
Location Address9785 S MARYLAND PKWY STE 2Las Vegas, NV 89183-7124
Mailing Address9756 Homestead Mesa StLas Vegas, NV 89141-8954
Phone(702) 474-0077
Sole ProprietorYes
Medical School CMSOtherGraduated 2024
Enumeration DateMarch 25, 2025
Last NPPES UpdateNovember 19, 20252 updates tracked since enumeration
NPPES CertifiedNovember 19, 2025
✔ NPI 1104628940 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 NV · 888784
9785 S MARYLAND PKWY STE 2, Las Vegas, NV 89183
Open in Google Maps ↗

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

Mr. Samuel Houston Lane V 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 ID9830677681
PECOS Enrollment IDI20260202002907
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 89183 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
$88.51 typical visit price
range $57.07 – $173.24
Typical copayment $22.12 (range $14.26 – $43.31)
Most-billed visit code 99203
Established Patient
$100.60 typical visit price
range $18.27 – $140.96
Typical copayment $25.15 (range $4.56 – $35.24)
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.

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 Lane's NPI number?

The NPI number for Samuel Lane is 1104628940. It was assigned to this individual provider in the NPPES registry on March 25, 2025.

Where is Samuel Lane located?

Samuel Lane practices at 9785 S Maryland Pkwy Ste 2, Las Vegas, NV 89183. The listed phone number is (702) 474-0077.

What is Samuel Lane's specialty?

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

Is Samuel Lane enrolled in Medicare?

Yes. Samuel Lane 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 Lane was last updated on November 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.