Sam Pennise, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

033360 Issued in NY

Practice address

28 Mechanic St
Box 386
Hammondsport, NY 14840

Phone

(607) 569-2242

Fax

(607) 569-2278

NPI assigned

May 11, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240876800000",
    "number": "1104031335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 MECHANIC STREET",
            "address_2": "BOX 386",
            "city": "HAMMONDSPORT",
            "state": "NY",
            "postal_code": "148400386",
            "telephone_number": "607-569-2242",
            "fax_number": "607-569-2278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 MECHANIC ST",
            "address_2": "BOX 386",
            "city": "HAMMONDSPORT",
            "state": "NY",
            "postal_code": "14840",
            "telephone_number": "607-569-2242",
            "fax_number": "607-569-2278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNISE",
        "first_name": "SAM",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-11",
        "last_updated": "2009-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "033360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Morrison, OTRL
• Kevin S Murray, RPH
• Nomad Smiles LLC
• Adam John Nudd, D.C.
• Park Pharmacy of Hammondsport
• Kelsey Spinks
• Cynthia Stocking, RN
• Jeanette Topper, M.A,CCC-SLP
• Bruce S Ushkow, M.D.
• Susan Marie Van Gelder, RN

• All providers in Hammondsport, NY
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.