SAMUEL STETKEVICH M.D.
NPI 1215687009
Student in an Organized Health Care Education/Training Program in Sacramento, CA
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, maintains 2 additional practice locations, and is a graduate of University Of Toledo College Of Medicine (2022).
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Locations 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Samuel Stetkevich M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Samuel Stetkevich reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Stockton, CA 95210
- Reassigned Medicare billing, California enrollment
- 20,078 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 13
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SACRAMENTO, CA 95816
SACRAMENTO, CA 95816
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 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.
Where is Samuel Stetkevich located?
Samuel Stetkevich practices at 3301 C St Ste 1400, Sacramento, CA 95816. The listed phone number is (916) 734-6111.
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.
Is Samuel Stetkevich enrolled in Medicare?
Yes. Samuel Stetkevich is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Samuel Stetkevich's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Stetkevich reassigns Medicare benefits to Permanente Medical Group Inc (Stockton, CA). The 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 Samuel Stetkevich'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 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.
# Samuel Stetkevich, M.D. · NPI 1215687009
Student in an Organized Health Care Education/Training Program provider in Sacramento, California. Individual provider, active in the CMS NPPES registry since March 25, 2022.
## Identity
- **NPI:** 1215687009 (Entity type: Individual)
- **Enumerated:** March 25, 2022
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **State license:** A189511 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 3301 C ST STE 1400, Sacramento, CA 95816-3367
- **Phone:** (916) 734-6111
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Permanente Medical Group Inc (NPI 1548343510, Stockton, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Toledo College Of Medicine, class of 2022
## Record status
- **NPPES last updated:** June 23, 2024
---
Source: [NPI Profile](https://npiprofile.com/npi/1215687009) · Data from the CMS NPPES public registry.