SAMANTHA MAE HIETALATI MD
NPI 1245617489
Pediatrics - Neonatal-Perinatal Medicine in San Diego, CA

Q: What is Samantha Hietalati's NPI number?

The NPI number for Samantha Hietalati is 1245617489. It was assigned to this individual provider in the NPPES registry on April 27, 2015. The provider is also known as Samantha Mae Harder MD.

Q: What is Samantha Hietalati's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Neonatal-Perinatal Medicine, with taxonomy code 2080N0001X.

Active since April 27, 2015PECOS Enrolled

3010 CHILDRENS WAY, SAN DIEGO, CA 92123(858) 966-5818 Get Directions Write a Review

NPPES record last updated: October 24, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Apr 12, 2022, Jul 31, 2018 (2 updates tracked since 2018).

On this page

About Samantha Mae Hietalati Md NPPES

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

SAMANTHA MAE HIETALATI MD (NPI 1245617489) is an individual neonatal-perinatal medicine provider in San Diego, California, licensed in California (A162427) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1245617489

Entity TypeIndividualFemale

Primary Taxonomy2080N0001X

Provider Legal NameSAMANTHA MAE HIETALATICredential: MD

Location Address3010 CHILDRENS WAYSan Diego, CA 92123-4223

Mailing Address3020 Childrens Way # Mc5003San Diego, CA 92123-4223 · (858) 309-6300

Phone(858) 966-5818

Sole ProprietorNo

Enumeration DateApril 27, 2015

Last NPPES UpdateOctober 24, 20242 updates tracked since enumeration

NPPES CertifiedOctober 24, 2024

✔ NPI 1245617489 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Neonatal-Perinatal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080N0001X

License✔ Licensed in CA · A162427

Definition

A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.

Also ListedPediatricsTaxonomy 208000000X · License A162427 (CA)

3010 CHILDRENS WAY, San Diego, CA 92123

Open in Google Maps ↗

Other Names 1

Former Name (1)Samantha Mae Harder Md

Secondary Practice Locations 2

Location 1200 W Arbor DrSan Diego, CA 92103-9000 · Phone (800) 926-8273 · Fax (888) 539-8781

Location 23750 Convoy St Ste 312San Diego, CA 92111-3741 · Phone (800) 926-8273 · Fax (888) 539-8781

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samantha Mae Hietalati Md 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 Reassignment

Medicare enrollment records show Samantha Hietalati reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Regents Of The University Of California

3.2 mi

Pediatrics

200 W ARBOR DR
San Diego, CA 92103

Reassigned Medicare billing, California enrollment
16 clinicians in this Medicare group

NPI 1386746741 (800) 926-8273

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 20

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

DR. KATHERINE N. NYMAN MD

Pediatrics (Neonatal-Perinatal Medicine)