Blue Green Horizons Office Based Surgery PLLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

176352 Issued in NY

Legal business name

BLUE GREEN HORIZONS OFFICE BASED SURGERY PLLC

Practice address

200 Brooklyn Ave
Brooklyn, NY 11213-1908

Phone

(718) 498-7888

Fax

(718) 604-7890

NPI assigned

Feb 23, 2010

Organization subpart

No

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

Authorized official

Name

Shelby K. Samuel, M.D.NPI 1114947157

Title

Owner

Phone

(718) 498-7888

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shelby Kevin Samuel, M.D.

  • Gastroenterology Physician
  • Brooklyn, NY
  • NPI 1114947157
  Medicare reassignment NPD Authorized official
• Zesong Zhang, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • New York, NY
  • NPI 1649522392
  Medicare reassignment NPD

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

{
    "created_epoch": "1266883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266883200000",
    "number": "1073835641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BROOKLYN AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112131908",
            "telephone_number": "718-498-7888",
            "fax_number": "718-604-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BROOKLYN AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112131908",
            "telephone_number": "718-498-7888",
            "fax_number": "718-604-7890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE GREEN HORIZONS OFFICE BASED SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-23",
        "last_updated": "2010-02-23",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "SHELBY",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-498-7888",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NY",
            "license": "176352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Multi-Specialty Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.