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MOMONA WOLDEMICAEL SAMUEL
NPI 1124793419
Nurse Practitioner - Family in Los Angeles, CA

Active since August 10, 2021PECOS EnrolledAccepts Medicare Assignment
808 W 58TH ST, LOS ANGELES, CA 90037(323) 541-1600 Get Directions Write a Review

NPPES record last updated: August 31, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Momona Woldemicael Samuel NPPES

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

MOMONA WOLDEMICAEL SAMUEL (NPI 1124793419) is an individual family provider in Los Angeles, California, licensed in California (95018215) and active in the NPI registry since August 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1124793419
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMOMONA WOLDEMICAEL SAMUEL
Location Address808 W 58TH STLos Angeles, CA 90037-3632
Mailing Address4619 S Orcas StSeattle, WA 98118-2432 · (323) 717-4003
Phone(323) 541-1600
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateAugust 10, 2021
Last NPPES UpdateAugust 31, 2021
NPPES CertifiedAugust 31, 2021
✔ NPI 1124793419 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
Licenses✔ Licensed in CA · 95018215✔ Licensed in WA · AP61155406
808 W 58TH ST, Los Angeles, CA 90037
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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

Momona Woldemicael Samuel 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 ID3072999663
PECOS Enrollment IDI20221005002037
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 90037 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
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
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 20

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

JOANNA CHOI MD
Pediatrics
808 W 58TH ST
LOS ANGELES, CA 90037
Los Angeles County (323) 541-1616
FELICIA KUO PA-C
Physician Assistant
808 W 58TH ST
LOS ANGELES, CA 90037
Los Angeles County (323) 541-1411
DR. YOUSEF TURSHANI M.D.
Pediatrics
808 W 58TH ST
LOS ANGELES, CA 90037
Los Angeles County (323) 541-1600
MS. JEHAN E REAGAN FNP
Nurse Practitioner (Family)
808 W 58TH ST
LOS ANGELES, CA 90037
Los Angeles County (323) 541-1411
MS. LAKESHA B JOHNSON P.A.-C
Physician Assistant
808 W 58TH ST, 2ND FLOOR
LOS ANGELES, CA 90037
Los Angeles County (323) 541-1600
MS. AELA PAIZ DO
Obstetrics & Gynecology
808 W 58TH ST
LOS ANGELES, CA 90037
Los Angeles County (323) 541-1600
MARIANA HERRERA
Marriage & Family Therapist
808 W 58TH ST
LOS ANGELES, CA 90037
Los Angeles County (323) 541-1600
IVY MARX R.D.
Dietitian, Registered
808 W 58TH ST
LOS ANGELES, CA 90037
Los Angeles County (323) 541-1600

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 Momona Samuel's NPI number?

The NPI number for Momona Samuel is 1124793419. It was assigned to this individual provider in the NPPES registry on August 10, 2021.

Where is Momona Samuel located?

Momona Samuel practices at 808 W 58th St, Los Angeles, CA 90037. The listed phone number is (323) 541-1600.

What is Momona Samuel's specialty?

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

Is Momona Samuel enrolled in Medicare?

Yes. Momona Samuel 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 Momona Samuel was last updated on August 31, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.