Samuel Benedict Maynard, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

8305 Issued in CT

Practice address

1 Shaws CV
New London, CT 06320-4902

Phone

(860) 447-8304

NPI assigned

Jul 22, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Intermountain Medical Group Denver LLCGroup PAC ID 0840513552, 571 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Joseph Hospital Hospital, Denver, CO, CCN 060028

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Intermountain Medical Group Denver, LLC

  • Family Medicine Physician
  • Denver, CO
  • NPI 1083021083
  Medicare reassignment Care Compare group NPD
• Intermountain Medical Group Denver, LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Denver, CO
  • NPI 1083598874
  NPD
• Intermountain Medical Group Denver, LLC

  • Family Medicine Physician
  • Thornton, CO
  • NPI 1407465107
  NPD

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

• Saint Joseph Hospital, Inc

  • General Acute Care Hospital
  • Littleton, CO
  • NPI 1164071296
  Care Compare affiliation
• Saint Joseph Hospital, Inc

  • General Acute Care Hospital
  • Denver, CO
  • NPI 1417946021
  Care Compare affiliation
• Saint Joseph Hospital, Inc

  • General Acute Care Hospital
  • Northglenn, CO
  • NPI 1427607464
  Care Compare affiliation
• Saint Joseph Hospital, Inc

  • General Acute Care Hospital
  • Aurora, CO
  • NPI 1619526746
  Care Compare affiliation

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1124671961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "749 9TH ST UNIT 203",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277051060",
            "telephone_number": "504-432-5708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SHAWS CV",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204902",
            "telephone_number": "860-447-8304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "SAMUEL",
        "middle_name": "BENEDICT",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-22",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "162343",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "8305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clementine A Masse, CRNA
• Matyas Family Dental, PLLC
• Janellen G Matyas, DDS
• Teresa Matyas
• Thomas James Matyas, DDS
• Oliver Mayorga, M.D.
• Sonja Mazzulli, O.T.
• Katherine McBurney, LCSW
• Lynn A McCaffrey, LCSW
• Jamar McClellan

• Family Nurse Practitioner in New London, CT
• Providers in New London, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; 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.