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Samuel W Kaufman

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

825 Trinity Ln, Claremont, CA 91711-2957

PECOS Enrollment

This provider is enrolled in PECOS as SAMUEL KAUFMAN.

Based on the most recent information from CMS, provider Samuel W Kaufman is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 4:18 PM.

Profile Details

Provider ID
1790811610
Provider Type
Individual
Full Name
Kaufman, Samuel W
Credential
MD

Gender
Male
Sole Proprietor
Yes
Enumeration Date
2/26/2007
Last Updated
4/20/2021

Contact Information

Practice Location

825 Trinity Ln, Claremont, CA 91711-2957

(909) 946-2801

(909) 946-3247

Mailing Location

PO Box 996, Upland, CA 91785-0996

(909) 920-1049

(909) 946-3247

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License A28426 California

Provider Identifiers

ID	Description	Issuer
ID 00A284260	Description Medicaid	Issuer Unlisted California

Samuel W Kaufman

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Vargas, Moises

Inland Psychiatric Medical Group, Inc

Akber, Bushra Ali

Pirard, Sandrine

Hodde, Ildiko J

Horowitz, Donald

Schmid Psychiatric Medical Corporation

Hope Psychiatric Medical Services,Inc.

Omnicore Health Services, Inc

Iqbal, Sulaiman