MR. SAM M FASSNACHT
NPI 1558670463
Physician Assistant - Medical in Patchogue, NY

Q: What is Sam Fassnacht's NPI number?

The NPI number for Sam Fassnacht is 1558670463. It was assigned to this individual provider in the NPPES registry on September 27, 2010.

Q: What is Sam Fassnacht's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Sam Fassnacht was last updated on December 28, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since September 27, 2010PECOS Enrolled

130 MEDFORD AVE, PATCHOGUE, NY 11772(631) 475-5734 Get Directions Write a Review

NPPES record last updated: December 28, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 28, 2016, Oct 13, 2016 (2 updates tracked since 2016).

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About Mr. Sam M Fassnacht NPPES

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

MR. SAM M FASSNACHT (NPI 1558670463) is an individual medical provider in Patchogue, New York and active in the NPI registry since September 2010. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1558670463

Entity TypeIndividualMale

Primary Taxonomy363AM0700X

Provider Legal NameMR. SAM M FASSNACHT

Location Address130 MEDFORD AVEPatchogue, NY 11772-1206

Mailing Address130 Medford AvePatchogue, NY 11772-1206

Phone(631) 475-5734

Sole ProprietorYes

Enumeration DateSeptember 27, 2010

Last NPPES UpdateDecember 28, 20162 updates tracked since enumeration

✔ NPI 1558670463 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

130 MEDFORD AVE, Patchogue, NY 11772

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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 (PECOS)

Mr. Sam M Fassnacht 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.

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553

DME-Other DME · category DE017N

2 suppliers16 claims16 services$197.98 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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Other Providers at the Same Location NPPES 8

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

DR. CHRISTINE MARIE DOUCET M.D.

Family Medicine