Individual provider Active NPI

Gonna Samuel, MD

  • Internal Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1104990472
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
196832 Issued in NY
Practice address
5314 Church Ave
Brooklyn, NY 11203-3609
Phone
(718) 240-9031
NPI assigned
Nov 20, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 196832 NY Primary

Addresses

Primary practice location

5314 Church Ave
Brooklyn, NY 11203-3609

Mailing address

958 Downing Rd
Valley Stream, NY 11580-1509
Phone (917) 302-8478

Other identifiers 1

IdentifierTypeStateIssuer
11019001500MedicaidNY

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
I20090406000391 NY Practitioner - Internal Medicine 4284781444 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Sinai School of MedicineGroup PAC ID 6406096544, 150 clinicians

Practice addresses (Care Compare)

1 Healthy Way
Oceanside, NY 11572-1551
Phone (516) 632-3670

Hospital & facility affiliations

  • Mount Sinai South Nassau Hospital, Oceanside, NY, CCN 330198

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
196832NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Sinai School of Medicine Internal Medicine CurrentSince Aug 1, 2019 Accepting new patients
Mount Sinai School of Medicine Internal Medicine Current Accepting new patients
Mount Sinai School of Medicine CurrentSince Aug 1, 2019 Accepting new patients
South Nassau Communities Hospital Past Accepting new patients

Locations

1 Healthy Way
Oceanside, NY 11572
Phone (516) 255-1581

Networks

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

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104990472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "958 DOWNING RD",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115801509",
            "telephone_number": "917-302-8478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5314 CHURCH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112033609",
            "telephone_number": "718-240-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "GONNA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "196832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11019001500",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.