Individual ProviderJason SamuelsPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2 Medical Plaza Dr Ste 225, Roseville, CA 95661-3044(916) 782-1291PECOS EnrollmentBased on the most recent information from CMS, provider Jason Samuels is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1033947957Provider TypeIndividualFull NameSamuels, JasonGenderMaleSole ProprietorYesEnumeration Date7/23/2024Last Updated12/3/2024Contact InformationPractice LocationPractice Address2 Medical Plaza Dr Ste 225, Roseville, CA 95661-3044Phone(916) 782-1291Fax(916) 782-5992Mailing LocationMailing Address121 Apex Loop Apt 301, Folsom, CA 95630-6967PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted Issuer