SAMUEL ANTONIO COLLAZO MD
NPI 1477017242
Student in an Organized Health Care Education/Training Program in Pittsburgh, PA

Q: What is Samuel Collazo's NPI number?

The NPI number for Samuel Collazo is 1477017242. It was assigned to this individual provider in the NPPES registry on January 25, 2019.

Q: What is Samuel Collazo'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 Collazo was last updated on March 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.

Active since January 25, 2019PECOS Enrolled

3459 5TH AVE # NW628, PITTSBURGH, PA 15213(412) 692-2212 Get Directions Write a Review

NPPES record last updated: March 29, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 29, 2026, Jan 25, 2019 (2 updates tracked since 2019).

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About Samuel Antonio Collazo Md NPPES

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

SAMUEL ANTONIO COLLAZO MD (NPI 1477017242) is an individual student in an organized health care education/training program in Pittsburgh, Pennsylvania and active in the NPI registry since January 2019. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1477017242

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameSAMUEL ANTONIO COLLAZOCredential: MD

Location Address3459 5TH AVE # NW628Pittsburgh, PA 15213-3236

Mailing Address3600 Forbes Ave Ste 140Pittsburgh, PA 15213-3410 · (412) 692-2212

Phone(412) 692-2212

Sole ProprietorYes

Enumeration DateJanuary 25, 2019

Last NPPES UpdateMarch 29, 20262 updates tracked since enumeration

NPPES CertifiedMarch 29, 2026

✔ NPI 1477017242 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

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

Taxonomy Code390200000X

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.

3459 5TH AVE # NW628, Pittsburgh, PA 15213

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel Antonio Collazo 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 Samuel Collazo reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Permanente Medical Group Inc

2,204 mi

Internal Medicine

7373 WEST LANE
Stockton, CA 95210

Reassigned Medicare billing, California enrollment
20,078 clinicians in this Medicare group

NPI 1548343510 (209) 476-2000

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 12

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

JOHN WILLIAM TEPPER

Internal Medicine (Pulmonary Disease)