Individual provider Active NPI

Ronald C Samuels, MD, MPH

  • Pediatrics Physician
  • Bronx, NY
National Provider Identifier
1023101250
Registry record updated Jul 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
183732 Issued in NY
Practice address
3411 Wayne Ave
Bronx, NY 10467-2509
Phone
(718) 741-2507
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 75654 MA
Pediatrics Physician 208000000X 183732 NY Primary

Addresses

Primary practice location

3411 Wayne Ave
Bronx, NY 10467-2509

Mailing address

3411 Wayne Ave
Bronx, NY 10467-2509
Phone (917) 801-5981

Other identifiers 1

IdentifierTypeStateIssuer
3137490MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220303000671 NY Practitioner - Pediatric Medicine 6901842137 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
75654MAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center Pediatrics CurrentSince Jan 14, 2022 Accepting new patients
Montefiore Medical Center CurrentSince Jan 14, 2022 Accepting new patients
Montefiore Medical Center Past Accepting new patients
Caritas Medical Group, Inc Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

3411 Wayne Ave
Bronx, NY 10467
Phone (718) 920-2680

3444 Kossuth Ave
Bronx, NY 10467
Phone (718) 920-2273

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: rosamuels@montefioredirect.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1023101250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3411 WAYNE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672509",
            "telephone_number": "917-801-5981",
            "fax_number": "718-405-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3411 WAYNE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672509",
            "telephone_number": "718-741-2507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "RONALD",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "75654",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "183732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3137490",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.