Sammy Sadi Abusrur, MD
Individual provider Active NPI Child & Adolescent Psychiatry Physician · Williston, VT
NPI 1114487899 · NPPES record last updated Sep 12, 2025
Key facts
- NPI
- 1114487899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Child & Adolescent Psychiatry Physician 2084P0804X
- License
- 042.0017055 (VT)
- Practice address
- 4185 St George Rd
Williston, VT 05495-7695 - Phone
- (802) 879-5333
- NPI assigned
- Mar 20, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- University of South Florida College of Medicine, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Burlington, VT 05402-1150
PO Box
Suite 1150
Burlington, VT 05402
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VT, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241203003335 | VT | Practitioner - Psychiatry | 6103150578 | Reassigns benefits to 1 organization |
| I20250922001036 | NY | Practitioner - Psychiatry | 6103150578 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 339684 | NY | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Champlain Valley Physicians Hospital Medical Center | Psychiatry | Current |
Accepting new patients |
| Central Vermont Medical Center Inc | Psychiatry | Current |
Accepting new patients |
Locations
75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100
130 Fisher Rd
#C
Berlin, VT 05602
Phone (802) 225-5400
111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415
Interoperability endpoints
- sabusrur219484@direct.uvmhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 339684 | NY | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 042.0017055 | VT | Yes |
| Psychiatry Physician | 2084P0800X | 042.0017055 | VT |
Addresses
Primary practice location
4185 St George Rd
Williston, VT 05495-7695
Mailing address
4185 St George Rd
Williston, VT 05495-7695
Phone (802) 651-7731
Other practice location 1
75 Beekman St
Plattsburgh, NY 12901-1438
Phone (518) 562-7790
Other providers in Williston, VT
- 802 Chiropractic LLC
- Nancy Hausner Abernathey
- Acdcdds, PC
- Acdcdds,PC
- Erin Miceli Adams
- Lauren Stefanie Adams
- Rebecca A. Adams
All providers in Williston, VT · Child & Adolescent Psychiatry Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.