NPIMap

Individual provider Active NPI

Samuel Leon Bridgers, M.D.

  • Neurology Physician
  • Hamden, CT
National Provider Identifier
1053303693
Registry record updated Oct 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
23624 Issued in CT
Practice address
2080 Whitney Ave
Suite 280
Hamden, CT 06518-3600
Phone
(203) 248-6200
Fax
(203) 248-5479
NPI assigned
Aug 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 23624 CT Primary

Addresses

Primary practice location

2080 Whitney Ave
Suite 280
Hamden, CT 06518-3600

Mailing address

2080 Whitney Ave
Suite 280
Hamden, CT 06518-3600
Phone (203) 248-6200

Other identifiers 4

IdentifierTypeStateIssuer
010023624CT05OtherCTANTHEM
682259OtherCOCTCARE
OV8177OtherCTHEALTHNET
NHS254OtherCTOXFORD HEALTHPLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23624CTMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Raphael Faculty Physicians Past Accepting new patients
Saint Raphael Healthcare System Affiliated Physicians Inc Neurology Past Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317686400000",
    "number": "1053303693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 WHITNEY AVE",
            "address_2": "SUITE 280",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065183600",
            "telephone_number": "203-248-6200",
            "fax_number": "203-248-5479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 WHITNEY AVE",
            "address_2": "SUITE 280",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065183600",
            "telephone_number": "203-248-6200",
            "fax_number": "203-248-5479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIDGERS",
        "first_name": "SAMUEL",
        "middle_name": "LEON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2011-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CT",
            "license": "23624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "010023624CT05",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CTCARE",
            "identifier": "682259",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "OV8177",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTHPLAN",
            "identifier": "NHS254",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamden, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.