SHINEY SAM
NPI 1770867905
Nurse Practitioner - Acute Care in Bethesda, MD
About Shiney Sam NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHINEY SAM (NPI 1770867905) is an individual acute care provider in Bethesda, Maryland, licensed in Maryland (R165191) and active in the NPI registry since October 2011. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Shiney Sam is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Shiney Sam reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Baltimore, MD 21201
- Reassigned Medicare billing, District of Columbia enrollment
- Medicare enrollment name: Shock Trauma Associates PA
- 24 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 20889 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
BETHESDA, MD 20889
BETHESDA, MD 20889
BETHESDA, MD 20889
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 Shiney Sam's NPI number?
The NPI number for Shiney Sam is 1770867905. It was assigned to this individual provider in the NPPES registry on October 6, 2011.
Where is Shiney Sam located?
Shiney Sam practices at 8901 Wisconsin Ave, Bethesda, MD 20889. The listed phone number is (301) 295-4000.
What is Shiney Sam's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.
Is Shiney Sam enrolled in Medicare?
Yes. Shiney Sam is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Shiney Sam's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Shiney Sam reassigns Medicare benefits to Shock Trauma Associates, P.A. (Baltimore, MD). 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 Shiney Sam'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 Shiney Sam was last updated on October 25, 2023. 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.
# Shiney Sam · NPI 1770867905
Acute Care physician in Bethesda, Maryland. Individual provider, active in the CMS NPPES registry since October 6, 2011.
## Identity
- **NPI:** 1770867905 (Entity type: Individual)
- **Enumerated:** October 6, 2011
- **Primary specialty:** Nurse Practitioner - Acute Care · taxonomy 363LA2100X
- **State license:** R165191 (Maryland)
- **Sole proprietor:** No
## Practice location
- **Address:** 8901 WISCONSIN AVE, Bethesda, MD 20889-0004
- **Phone:** (301) 295-4000
## 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:** Shock Trauma Associates, P.A. (NPI 1679512909, Baltimore, MD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 25, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1770867905) · Data from the CMS NPPES public registry.