Shelby Kevin Samuel, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

176352 Issued in NY

Practice address

200 Brooklyn Ave
Brooklyn, NY 11213-1908

Phone

(718) 498-7888

Fax

(718) 604-7890

NPI assigned

Jul 20, 2006

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

Other identifiers 1

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

Specialty

Gastroenterology

Education

State University of New York Downstate Medical Center, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: shelby.samuel.1@24787.direct.athenahealth.com

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.

• Blue Green Horizons Office Based Surgery PLLC

  • Multi-Specialty Clinic/Center
  • Brooklyn, NY
  • NPI 1073835641
  Medicare reassignment NPD Authorized official
• West Side Radiology Associates, PC

  • Radiological Physics Physician
  • New York, NY
  • NPI 1568519833
  NPD (past)

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328832000000",
    "number": "1114947157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 391",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106020391",
            "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": {
        "last_name": "SAMUEL",
        "first_name": "SHELBY",
        "middle_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2012-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "176352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01448966",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ossama R Samuel, M.D.
• Pnina Samuel
• Preethi Susan Samuel, PHARMD
• Racquel Latiesha Samuel, LCSW
• Sandra Samuel
• Stanley Samuel, M.D.
• Vanessa Samuel
• Vexcelia Viola Samuel, AGNP
• Wendetha R Samuel
• Samuel'S Kids

• Gastroenterology Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Gastroenterology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; 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.
• 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.