Individual provider Active NPI

Sam Scott Sorrentino, MD

  • Psychiatry Physician
  • Medford, OR
National Provider Identifier
1154940401
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD219688 Issued in OR
Practice address
200 Beatty
Medford, OR 97501-5811
Phone
(541) 476-2373
NPI assigned
Apr 15, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD219688 OR Primary
Psychiatry Physician 2084P0800X 328669 NY

Addresses

Primary practice location

200 Beatty
Medford, OR 97501-5811

Mailing address

1215 SW G St.
Grants Pass, OR 97526-2544
Phone (541) 476-2373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, OR2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240627003665 NY Practitioner - Psychiatry 8325582679 Reassigns benefits to 1 organization
I20240930003142 OR Practitioner - Psychiatry 8325582679 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Options for Southern OregonGroup PAC ID 0941202006, 70 clinicians

Practice addresses (Care Compare)

200 Beatty St
Medford, OR 97501-5811
Phone (541) 476-2373

Hospital & facility affiliations

  • Asante Rogue Regional Medical Center Hospital, Medford, OR, CCN 380018
  • Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
328669NYMDLicensed Practical Nurse
MD219688ORMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Options for Southern Oregon CurrentSince Nov 1, 2024 Accepting new patients
Options for Southern Oregon CurrentSince Nov 1, 2024 Accepting new patients
Psychiatry Faculty Practice, Inc. Psychiatry CurrentSince Jul 1, 2024 Accepting new patients
Suny Health Science Center at Syracuse Past Accepting new patients
Suny Health Science Center at Syracuse Past Accepting new patients

Locations

719 Harrison St
Syracuse, NY 13210
Phone (315) 464-3265

713 Harrison St
Bldg 3
Syracuse, NY 13210
Phone (315) 464-3265

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

1215 SW G St
Grants Pass, OR 97526
Phone (541) 244-4109

200 Beatty St
Medford, OR 97501
Phone (541) 414-0739

Interoperability endpoints

  • Direct secure messaging: ssorrentino106662@direct.upstate.edu

Organizations & group practices 5

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 2

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": "1586908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1154940401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 SW G ST.",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975262544",
            "telephone_number": "541-476-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BEATTY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975015811",
            "telephone_number": "541-476-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SORRENTINO",
        "first_name": "SAM",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-15",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD219688",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "328669",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.