SAMUEL STETKEVICH M.D.
NPI 1215687009
Student in an Organized Health Care Education/Training Program in Sacramento, CA

Q: What is Samuel Stetkevich's NPI number?

The NPI number for Samuel Stetkevich is 1215687009. It was assigned to this individual provider in the NPPES registry on March 25, 2022.

Q: What is Samuel Stetkevich's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Samuel Stetkevich was last updated on June 23, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since March 25, 2022PECOS Enrolled

3301 C ST STE 1400, SACRAMENTO, CA 95816(916) 734-6111 Get Directions Write a Review

NPPES record last updated: June 23, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Samuel Stetkevich M.d. NPPES

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

SAMUEL STETKEVICH M.D. (NPI 1215687009) is an individual student in an organized health care education/training program in Sacramento, California, licensed in California (A189511) and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1215687009

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameSAMUEL STETKEVICHCredential: M.D.

Location Address3301 C ST STE 1400Sacramento, CA 95816-3367

Mailing Address3301 C St Ste 1400Sacramento, CA 95816-3367 · (916) 734-6111

Phone(916) 734-6111

Sole ProprietorNo

Enumeration DateMarch 25, 2022

Last NPPES UpdateJune 23, 2024

NPPES CertifiedJune 23, 2024

✔ NPI 1215687009 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

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

Taxonomy Code390200000X

License✔ Licensed in CA · A189511

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.

Also ListedInternal MedicineTaxonomy 207R00000X · License A189511 (CA)

3301 C ST STE 1400, Sacramento, CA 95816

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Secondary Practice Locations 2

Location 17515 Van Nuys BlvdVan Nuys, CA 91405-1949 · Phone (818) 627-3000

Location 214445 Olive View DrSylmar, CA 91342-1437 · Phone (747) 210-3000

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel Stetkevich M.d. 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.

Other Providers at the Same Location NPPES 16

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

STEPHANIE T LE MD

Dermatology